丙泊酚复合不同阿片类药物在无痛胃镜检查中的应用

The Application of propofol combined with different opioid drugs anesthesia in the pain-free gastroscopy

目的比较丙泊酚复合不同阿片类药物在无痛胃镜检查中的应用效果。方法拟行无痛胃镜检查的患者240例,ASA Ⅰ～Ⅱ级,年龄25～60岁,体重45～75kg。随机分为四组,每组60例。P组静脉注射丙泊酚1～2.5mg/kg,F组静脉注射芬太尼0.8μg/kg,S组静脉注射舒芬太尼0.08μg/kg,R组静脉注射瑞芬太尼0.5μg/kg,除P组外各组均静脉注射丙泊酚1～2mg/kg,意识消失时置入胃镜,术中酌情追加丙泊酚0.5～1mg/kg,观察四组患者丙泊酚用量、清醒时间、视觉模拟评分(VSA),评价清醒时和1h后疼痛程度及不良反应发生情况。结果与P组比较,F组、S组、R组丙泊酚用量减少(P<0.05);与F组和S组比较,R组丙泊酚用量减少(P<0.05)、R组低氧血症发生率增加(P<0.05);与P组比较,F组、S组、R组清醒时间缩短,清醒时VSA疼痛评分减低(P<0.05)、清醒1hVSA评分减低(P<0.05);除P组外各组清醒时间差异无统计学意义(P>0.05);与F组和R组比较,S组清醒1hVSA评分减低(P<0.05)。结论丙泊酚复合不同阿片类药物应用于无痛胃镜检查手术比单一使用丙泊酚组丙泊酚用量减少、对呼吸的抑制少、清醒时间缩短、清醒时舒适程度高。在无痛胃镜检查中0.5μg/kg瑞芬太尼组较0.8μg/kg芬太尼组和0.08μg/kg舒芬太尼组丙泊酚用量减少,但对呼吸的抑制重。舒芬太尼组术后舒适程度优于芬太尼组及瑞芬太尼组。

Objective To compare the effect of propofol combined with different opioid drug anesthesia on the pain-free gastroscopy. Methods Two hundred and fourty ASA Ⅰ or Ⅱ patients aged 25 - 60 years weighing 45 - 75 kg were randomly divided into 4 groups（n =60） ： group P received propofol 1 -2. 5 mg/kg;group F received fentanil 0. 8 μg/kg;group S received suffentanil 0.08 μg/kg; group R received remifentanil 0. 5 μg/kg slowly iv. Lidocaine 20 mg and propofol 1 - 2 mg/kg were then injected slowly iv except group P until consciousness was lost and eyelash reflex disappeared. Gastroscopy was started when the consciousness disappeared. Intermittent iv boluses of propofol 0.5 - 1 mg/kg were given dtrring operation when necessary. The total dosage of propofol used for induction, awakening time, the score of VSA were observed. The level of pain at awaking and at 1 hoHr after awning,and side effects were evaluated. Results The total dosage of propofol used for induction was significantly lower in group R, group F and group S than that in group P （P 〈 0.05 ） ; the total dosage of propofol used for induction was significantly lower in group R than group F and group S （P 〈 0. 05）. The rate of hypoxemia was increased in group R than group F and group S （P 〈 0. 05 ） ;The awaking time was shorter and visual simulation score at awaking was lower in group F, group S and group R than in group P. There were no significant differences in awaking time and visual simldation score at awaking in other groups except group P;the VSA at 1 hour after awaking in group S was lower than group F and group R （ P 〈 0. 05 ）. Conclusion The total dosage of propofol used for induction is lower in propofol combined with different opioid drug anesthesia than single uea propofol in the pain-free gastroscopy, the total of propofol used for induction is lower in 0. 5 μg/kg remifentanil group than in 0. 8 μg/kg fentanil group and 0. 08 μg/kg suffentanil group, the rate of hypoxemia was increased in group R than group F and group S.