纤维结肠镜检查术患者舒芬太尼鼻腔给药的效果

Intranasal versus intravenous sufentanil for analgesia-sedation in patients undergoing fiberoptic colonoscopy

目的比较纤维结肠镜检查术患者舒芬太尼鼻腔给药的效果。方法 择期纤维结肠镜检查术患者60例，ASAⅠ或Ⅱ级，年龄32—78岁，体重50～85kg，随机分为3组，每组20例。Ⅰ组静脉注射舒芬太尼0．1μg／kg，Ⅱ组和Ⅲ组分别经鼻滴入舒芬太尼0．13、0．1μg／kg，舒芬太尼均用生理盐水稀释至1ml。各组均静脉注射利多卡因50mg和异丙酚1～3mg／kg，意识消失时置入纤维结肠镜，静脉输注异丙酚50μg·kg^-1·min^-1维持麻醉。术中酌情追加异丙酚0．5～1．0mg／kg。于给药前（T0）、给药后2、3、4min（T1-3）及清醒时（T4）监测平均动脉压（MAP）、心率（HR）和脉搏血氧饱和度（SpO2），记录异丙酚诱导量：总量、术中OAA／S评分、体动反应、检查时间、清醒时间，记录术后恶心、呕吐及嗜睡等不良反应的发生情况。结果各组检查时间、清醒时间、异丙酚诱导量、异丙酚总量、术中OAA／S评分差异无统计学意义（P〉0．05）；与L时相比，各组，T1-4时MAP降低，Ⅰ组T1-2时SpO2降低（P〈0．05或0．01）；与Ⅱ组和Ⅲ组相比，Ⅰ组T1时SpO2降低（P〈0．05）；Ⅱ组和Ⅲ组各时点SpO2差异无统计学意义（P〉0．05）；术后均未见恶心、呕吐、嗜睡等不良反应发生。结论纤维结肠镜检查术患者舒芬太尼0．1μg／kg鼻腔给药较静脉给药对呼吸功能的抑制轻。

Objective To compare the analgesia and sedation produced by intranasal and intravenous sufentanil in patients undergoing fiberoptic colonoscopy. Methods Sixty ASA Ⅰ or Ⅱ patients aged 32-78 yr weighing 50-85 kg were randomly divided into 3 groups （n = 20 each）： group Ⅰ received sufentanil 0.1 μg/kg injected slowly iv; group Ⅱ and Ⅲ received intranasal instillation of sufentanil 0.13 and 0.1μg/kg respectively. Sufentanil was diluted to 1 ml in all 3 groups. Lidocaine 50 mg and propofol 1-3 mg/kg were then injected slowly iv until consciousness was lost and eyelash reflex disappeared. Fiberoptic colonoscopy was started. Sedation was maintained with continuous infusion of propofol at 50μg· kg^-1 ·min^-1. Intermittent iv boluses of propofol 0.5-1.0 mg/kg were given during operation when necessary. MAP, FIR and SpO2 were continuously monitored and recorded before （To, baseline） and 2, 3, 4 min after sedation was induced （T1,2,3 ） and when the patients were awake （T4 ）. The level of sedation was assessed using observer＇s assessment of alertness/sedatlon scale （OAA/S）. Body movement in response to surgical stimuli, awakening time, side effects, the amount of propofol used for induction of sedation and the total amount of propofol used during operation were recorded and compared among the 3 groups. Results The 3 groups were comparable with respect to age, sex ratio, body weight and height. There were no significant differences in duration of colonoscopy, awakening time, the amount of propofol used for induction, the total amount of propofol and OAA/S scores among the 3 groups. There were no postoperative nausea and vomiting and somnolence. SpO2 was significantly lower at T1 in group Ⅰ than in group Ⅱ and Ⅲ , but there was no significant difference in SpO2 at all time points between group Ⅱ and Ⅲ . MAP was significantly decreased at T1-4 as compared with the baseline at To in all 3 groups. Conclusion Sufentanil 0.1 μg/kg administered intranasally is better than that given iv in terms of respiratory depression.