阿托品对丙泊酚在肠镜检查中麻醉效果和安全性的影响

Influence of atropine on anesthetic effect and safety of propofol during enteroscopy

目的:观察阿托品对丙泊酚在肠镜检查中麻醉效果和安全性的影响。方法:2008年3月至7月拟行肠镜检查患者共80例纳入研究并分为2组:试验组和对照组,每组40例。试验组中,男23例,女17例,平均年龄(53±19)岁。对照组中,男26例,女14例,平均年龄(50±22)岁,试验组患者给予0.1 mg/ml阿托品0.25～0.5 ml用0.9%氯化钠注射液稀释至5ml,缓慢静脉推注,再缓慢静脉推注丙泊酚1.5～2.5 mg/kg(推注时间>30 s)。对照组患者单用丙泊酚,用法用量同试验组。记录给药前和给药后5、10 min患者的心率、血压、血氧饱和度,观察肢体活动度、清醒时间及丙泊酚用量和不良反应。结果:2组患者给药前与给药后5 min比较,心率均有降低,试验组分别为(77.2±8.9)次/min与(73.5±9.1)次/min;对照组分别为(79.7±7.2)次/min与(68.4±12.3)次/min,差异均有统计学意义(均P<0.01)。2组收缩压及血氧饱和度给药前与给药后5 min比较均降低,试验组分别为(136±12.5)mm Hg和(123.2±14.3)mm Hg,(97.5±0.8)%和(95.2±0.7)%;对照组分别为(138±14.6)mm Hg和(108±12.2)mm Hg,(97.8±0.7)%和(90.3±0.8)%,组间比较,对照组较试验组下降明显,差异均有统计学意义(均P<0.01);试验组与对照组肢体活动度总分分别为22分与46分、清醒时间分别为(2.8±1.3)min与(4.8±2.1)min,丙泊酚用量分别为(124±16)mg与(138±20)mg,组间比较差异均有统计学意义(均P<0.01)。试验组和对照组的不良反应发生率分别为65%与87.5%,其中血氧饱和度<80%者分别为2.5%与10%,心动过缓为0%与12.5%,过敏性红斑为7.5%与12.5%。结论:丙泊酚与阿托品联用是一种安全有效无痛肠镜检查的麻醉方法。

Objective： To observe the influence of atropine on anesthetic effect and safety of propofol during enteroscopy. Methods ： Between March 2008 and July 2008, eighty patients planning to undergo enteroscopy were enrolled in the study and divided into two groups： the test group and the control group （40 cases in each group）. The test group comprised 23 men and 17 women with average age （53 ± 19） years. The control group comprised 26 men and 14 women with average age （ 50 ±22） years. The patients in the test group received an slow IV push of 0.25-0.5 ml of atropine 0. 1mg/ml diluted in sodium chloride 0.9% to total of 5 ml, and slow IV push of propofol 1.5-2.5 mg/kg in not less than 30 seconds. The patients in the control group received propofol alone, the dosage and administration were the same as those in the test group. The patients＇ heart rate, blood pressure, and blood oxygen saturation before and 5, 10 minutes after administration, limb movement, period of consciousness, dosage of propofol, and adverse reactions were observed and recorded. Results： The heart rate of patients in both groups decreased 5 minutes after administration compared with before administration： （77.2 ± 8.9） beats/min vs （73.5 ± 9.1 ） beats/min, respectively, in the test group ; （79.7 ± 7.2） beats/min vs （68.4 ± 12.3 ） beats/min, respectively, in the control group. The different in heart rate was statistically significant （all P 〈 0.01 ）. The systolic pressure and blood oxygen saturation in both groups decreased 5 minutes after drug administration compared with before drug administration： （136±12.5） mm Hg vs （123.2±14.3） mm Hg and （97.5 ±0.8）% vs （95.2 ± 0.7）%, respectively, in the test group; （138±14.6） mm Hgvs （108±12.2） mmHgand （97.8±0.7）% vs （90.3±0.8）%, respectively, in the control group. Systolic pressure and blood oxygen saturation markedly decreased in the control group compared with the test group, the differences were statistically significant （all P 〈 0.01 ）. In the test and control groups, the total scores of limb movement was 22 and 46, the consciousness period was （2.8 ± 1.3 ） min and （ 4.8 ± 2.1 ） min, and the total dosage of propofol was （ 124 ± 16） mg and （ 138 ±20） mg, respectively; the differences between the two groups were statistically significant （ all P 〈 0. 01 ）. The incidence of adverse reactions in the test and control groups were 65% and 87.5%, respectively, including blood oxygen saturation 〈80% （2.5% vs 10.0% ）, bradycardia （0% vs 12.5% ）, and allergic erythema （7.5% vs 12.5% ）. Conclusion： Propofol combined with atropine is an effective and safe anesthetic regimen for painless enteroscopy.