不同剂量瑞芬太尼复合丙泊酚在无痛胃镜检查中的应用比较

Comparision of the effect of different doses of remifentanil combined with propofol for painless gastroscopy

目的比较不同剂量瑞芬太尼复合丙泊酚在无痛胃肠镜检查中的效果。方法按美国麻醉医师协会（ASA）体格情况分级Ⅰ-Ⅱ级行胃镜检查的患者120例，随机分成3组，每组40例。Ⅰ组：瑞芬太尼0．3μg／kg＋丙泊酚1．5mg/kg；Ⅱ组：瑞芬太尼0．5μg／kg＋丙泊酚1．5mg／kg；m组：瑞芬太尼1．0μg/kg＋丙泊酚1．5mg／kg。胃镜检查前静脉推注，记录麻醉前后生命体征变化（包括血压、心率、呼吸频率、血氧饱和度等），比较生命体征变化及麻醉起效时间、维持时间、苏醒时间，观察胃镜检查术中不良反应发生情况（包括体动、低血压、心动过缓、呼吸暂停等）。结果麻醉前后生命体征变化及麻醉起效时间、维持时间、苏醒时间比较差异无统计学意义（P〉0．05），而Ⅰ组的体动例数明显高于Ⅱ组和Ⅲ组（P〈0．05），Ⅲ组心动过缓、低血氧发生率明显高于Ⅰ组和Ⅱ组（P〈0．05），三组间低血压、体动和呼吸暂停发生率比较差异均有统计学意义（P〈0．05）。结论使用瑞芬太尼0．5μg／k＋丙泊酚1．5mg／kg的患者不良反应发生率低，更安全，适合于无痛胃镜的检查。

Objective To evaluate the efficacy of different doses of remifentanil combined with propofol for painless gastroscope of outpatients. Methods One hundred and twenty outpatients performed with painless gastroseope were randomly divided into three groups： group Ⅰ （ remifentanil 0.3 μg/kg ＋ propofol 1.5 mg/kg, n =40）, group Ⅱ （ remifentanil 0.5 μg/kg ＋ propofol 1.5 mg/kg, n =40）, group Ⅲ （remifentanil 1.0 μg/kg ＋ propofol 1.5 mg/kg, n =40）. Before gastroseope, the outpatients were anaesthetized. Blood pressure, heart rate, respiration rate and SpO2, the onset time, the maintenance time and the recovery time of consciousness were recorded. Body movement, hypotension, bradycardia and apnea were observed. Results There was no significant difference in onset time, maintenance time and recovery time of consciousness in the three groups （P 〉 0.05）. Compared with group Ⅰ, the body movement in group Ⅱ and group Ⅲ was significantly decreased （P 〈 0.05）. The morbidity of hypotension and bradycardia in group Ⅲ was higher than that in group Ⅰ and group Ⅱ （ P 〈 0.05）. Conclusions Remifentanil 0.5 μg/kg ＋ propofol 1.5 mg/kg could be an effective dose for painless gastroseope of outpatients because of less side effects.