手控与靶控输注瑞芬太尼用于自主呼吸患者的比较研究

背景丙泊酚和瑞芬太尼联合输注用于保留自主呼吸患者的深度镇静时常常会发生一些副反应，尤其是呼吸抑制。这些副反应的产生可能与药物的组合以及给药技术有关。靶控输注（TCI）可能会优化给药方法。因此，在这项对择期结肠镜检术患者进行的前瞻性随机双盲研究中，我们试图回答以下两个问题：第一，使用丙泊酚的同时加用瑞芬太尼是否利大于弊。第二，与手控输注相比，靶控输注瑞芬太尼是否可以减少副反应的发生。方法接受择期结肠镜检术的患者被随机分组：接爱手控持续输注瑞芬太尼细（MCI）（0．125μg·kg^-1·min^-1的速度持续输注2分钟后改为0．05μg·kg^-1·min^-1的速度持续输注），靶控输注瑞芬太尼组（TCI）（1ng／ml），或安慰剂组（生理盐水靶控输注或以相应的速度手控持续输注）。所有患者都接受丙泊酚靶控输注，调整靶浓度至相应水平使得患者处于深度镇静、对语言指令无反应的同时保留自主呼吸且不需要辅助通气。结果安慰剂组发生沐动、咳嗽和呃逆、暂时干扰检查操作的人数显著多于研究绍、各组间血流动力学和苏醒指标没有显著临床差异．靶控输注瑞芬太尼减少了丙泊酚的用量。使用瑞芬太尼时，靶控输注组（TCI）与手控输注组（MCI）相比，呼吸减弱和呼吸暂停的发生率明显减低（TCI：n=7，MCI：n=16，P〈0．05）.结论瑞芬太尼和丙泊酚联合应用于保留自主呼吸的深度镇静时比单独丙泊酚能提供更好的结肠镜检术条件与手控输注瑞芩太尼相比，靶控输注瑞芬太昆可以减少丙泊酚的用量并减少呼吸暂停和呼吸抑制的发生率（TCI：n=7，MCI：n=16，P〈0．05）.

BACKGROUND： The combination of propofol-remifentanil for procedural deep sedation in sponta-neously breathing patients is characterized by the frequent incidence of side effects, especially respiratory depression. These side effects may be due to either the drug combination or the drug delivery technique. Target-controlled infusion （TCI） might optimize drug delivery. In this prospective, randomized, double-blind study in patients undergoing elective cx）lonoscopy, we thus tried to answer two questions： first, if adding remifentanil to propofol surpasses the disadvantages of the combination of these two products, and second, if administration of remifentanil via TCI decreases the incidence of side effects, compared to manually controlled administration. METHODS： Patients undergoing elective colonoscopy were randomly assigned to receive remifentanil via manually controlled continuous infusion （MCI） （0. 125 μg·kg^-1·min^-1 for 2 min followed by a continuous infusion of 0. 05 μg·kg^-1·min^-1）, TCI remifentanil （1 ng/ml）, or placebo （normal saline either as TCI or nmnual infusion of equivalent rate）. All patients received TCI propofol, adjusted to a target concentration level that provided deep sedation in which patients were not responsive to verbal commands, but maintained spontaneous ventilation without assistance. RESULTS： Signifi- candy more patients in the placebo group showed movement, cough and hiccup, which transiently interfered with the examination. There were no dinically significant differences in hemodynamic or recovery variables among all groups. Remifentanil administered via TCI resulted in a decrease in propofol requirements. The incidence of hypopnea and apnea was less frequent when remifentanil was administered via TCI compared to MCI （TCI n = 7, MCI n = 16, P 〈 0.05）. CONCLUSION： The combination of remifentanil and propofol for deep sedation in spontaneously breathing patients, offered better conditions for colonoscopy than propofol used as a single drug. Remifentanil administered via TCI resulted in a decrease in propofol dosing and in a lower incidence in apnea and respiratory depression （TCI n = 7, MCI n = 16, P〈0.05）, compared to manually controUed administration of remifentanil.