异丙酚靶控镇静在ICU危重病人内镜下无痛胃和空肠造口术中的应用

Application of propofol target controlled infusion for endoscopic gastrostomy and jejunostomy of critical patients in ICU

目的:研究多种镇静条件下,危重病人内镜下经皮穿刺胃造瘘和胃空肠造瘘术中、术后情况变化,探讨异丙酚靶控镇静在重症病人PEJ/PEG中的应用价值。方法;32例收住ICU危重病人随机分为3组:异丙酚(靶控)组,异丙酚(人工推注)组和地西泮复合咪达唑仑组,监测并记录患者术前10min至术后RamsayⅡ级前(术后监测10min)全程持续监测心电波形、呼吸、SPO2,血压。记录手术持续时间,术后至Ram-sayⅡ级时间,以及手术30分钟后患者对手术过程的主观回忆。结果:异丙酚(靶控)组术中呼吸(16.09±2.70)次/min,术中SP02(94.93±3.71)%、术后SP02(98.48±1.26)%,较其他两对照组稳定(P<0.05):术中收缩压(128.59±11.34)mmHg、术后收缩压(131.12±10.36)mmHg,较异丙酚(人工推注)组稳定(P<0.05):其负荷剂量后的心率(72.03±13.92)次/分、呼吸(15.47±1.92)次/min,术中心率(71.58±6.84)次/min,术后心率(75.83±8.14)次/min、SP02(98.48±1.26)%,较地西泮复合咪达唑仑组镇静负荷剂量下平稳(P<0.05);苏醒时间(3.27±0.84)min,较地西泮复合咪达唑仑组短(P<0.05)。同时异丙酚(靶控)组手术耗时(24.86±5.64)min、术中躁动发生率0.0%,术后无痛苦回忆发生率0.0%,优于两对照组(P<0.05)。结论:在危重病人中开展异丙酚靶控镇静下实施PEJ/PEG效果满意,患者术中平稳度高、手术依从性好、操作时间短、术后恢复快、无不良记忆留存,从而减少危重患者机体应激反应,保障营养支持的稳定实施,有助病情恢复。

Objective： To observe the Intraoperative and postoperative changes of percutaneous endoscopic gastrostomy（ PEG） and jejunestomy（PEJ ） in critical patients under the various sedative conditions, further to explore the application of propofol target controlled infusion（TCI） for PEJ/PEG of critical patients. Methods： 32 cases in ICU were randomly divided into 3 groups： propofol（ TCI ）group, propofol （artificial injection ）group and diazopam combined with midazolam group, monitoring and recording electrocardiogram wave form, respiration, SPO2 and blood pressure from 10 rain before operation to Ramsay≤Ⅱ after operation （postoperative monitoring≥ 10min）. Recording the operative duration, the time from postoperation to Ramsay≤Ⅱ and the operative process＇ subjective recall of patients at 30min after operation. Results： In propoful （TCI） gronp, intraoperative SPO2 （94.93 ± 3.71） % and postoperative SPO2 （98.48 ± 1.26） % were more stable than the other two groups （P 〈 0.05 ） ; intraoperative systolic pressure （128.59 ± 11.34） mmHg and postoperative systolic pressure（ 131.12 ± 10.36） mmHg were more stable than propofol（artificial injection） group; heart rate after loading dose （72.03 ± 13.92） /min, respiration （15.47 4± 1.92） /min, intraoperative heart rate （ 71.58 ± 6.84） /min, postoperative heart rate （ 75.83 ± 8.14 ） /min and SPO2 （ 98.48 × 1.26 ） % were more stable than diazepam combined with midazolam group （P 〈 0. 05 ） ： recovery time （ 3.27 ±0. 84 ） min was shorter than diazepam combined with midazolam group （ P 〈 0.05 ） . Meanwhile, in propofol（TCI） group, operative duration （24.86 ± 5.64）min,intraoperative restlessness incidence 0.0% and postoperative painless recall incidence 0.0% were better than the other two groups （P 〈 0. 05 ） . Conclusion： It was satisfying to apply propnfol target controlled infusion for PEJ/PEG in critical patients, which could decrease the stress responses of patients and maintain nutritional support for its high intraoperative stability, good operative compliance, short operative duration, quicker postoperative recovery and no painful memory.