脑电双频指数指导老年患者无痛胃肠镜联合检查

BIS guides painless combined gastrointestinal endoscopy in aged patients

目的探讨老年患者无痛胃肠镜联合检查的用药安全。方法选择60例实施无痛胃肠联合镜检查的老年患者。随机分为两组,Ⅰ组（n=30）：丙泊酚复合芬太尼;Ⅱ组（n=30）：丙泊酚复合咪唑安定-芬太尼。以脑电双频指数（BIS）监测为指导,当BIS值≤70时开始置镜,检查中BIS值维持在50-70范围。结果丙泊酚总用药剂量Ⅰ组（205.3±33.0）mg显著多于Ⅱ组（127.3±30.3）mg（P〈0.01）,镜检中血压、心率最低值Ⅰ组[（88.0±7.1）mmHg、（56.0±5.9）次/min]低于Ⅱ组[（110.8±16.6）mmHg、（61.0±4.3）次/min]（P〈0.01）。两组呼吸暂停（53.3%vs 43.3%）、低氧血症（6.7%vs 6.7%）均发生在首次给药时,为一过性。镜检中无知晓,麻醉效果满意。苏醒时间Ⅱ组（3.8±1.1）min长于Ⅰ组（2.7±1.1）min（P〈0.05）。结论丙泊酚复合少量的咪唑安定-芬太尼,是老年患者无痛胃肠镜联合检查的理想选择。

Objective To explore a safe method of administering drugs for painless combined gastrointestinal endoscopy in aged patients through comparing two different methods of administering drugs under the guide of BIS. Methods Sixty patients （age between 65-87 ） undergoing painless combined gastrointestinal endoscopy were randomly divided into two groups, group Ⅰ （propofol combined with fentanyl, n =30） and group Ⅱ （propofol combined with midozalam and fentanyl,n =30）. The drugs were administered under the guide of BIS,the endoscope was inserted when the BIS was below 70. During the procedures the BIS was between 50-70. Results The total dose of propefol was significantly higher in group Ⅰ compared to that in group Ⅲ （205.3 ± 33.0） mg vs （ 127.3 ± 30. 3mg） ] （ P 〈 0.01 ）. The minimal values of BP [ （ 88.0 ± 7.1 ） mmHg vs （ 110.8 ± 16.6） mmHg ] and HR [ （56.0 ± 5.9） /min vs （61.0 ± 4.3 ）/mini were significantly lower in group Ⅰ compared to those in group Ⅱ（P 〈 0.05 ）. BP and HR in group Ⅰdecreased obviously during the procedures. Apnea（53.3% vs 43.3% ） and Anoxemia（ 6. 7% vs 6.7% ）occurred at the first time of giving intravenous drugs in both groups ,and all above were transient. No patient woke during the procedure. Satisfactory anesthetic was obtained. The awaking time in group Ⅱ （3.8 ± 1.1 min） was much longer than that in group Ⅰ （ 2.7 ± 1.1 min） （ P 〈 0.05 ）. Conclusion Propofol combined with a low dose of midazolam and fentanyl was safe and effective for the procedures of painless combined gastrointestinal endoscopy.