地佐辛复合丙泊酚用于肝硬化患者无痛胃镜检查的临床研究

Clinical Study of Dezocine Combined with Propofol in the Painless Gastroscopy in Patients with Cirrhosis

目的探讨地佐辛复合丙泊酚用于肝硬化患者胃镜检查的安全性和可行性。方法选择该院2013年6月—2015年6月肝硬化无痛胃镜检查患者60例,随机分为地佐辛组(D组)、舒芬太尼组(S组)和对照组(C组),每组20例。D、S、C组分别静注地佐辛0.05 mg/kg、舒芬太尼0.2μg/kg、生理盐水5 m L,之后给予丙泊酚。记录HR、MAP、SPO2、胃镜检查时间、苏醒时间、丙泊酚诱导量及总用量、体动反应等级和麻醉满意度评分,术中不良反应发生情况。结果 S、D组丙泊酚诱导量分别为(85.5±10.6)mg、(87.3±10.7)mg,总用量分别为(121.2±20.3)mg、(127.5±17.6)mg,明显少于C组诱导剂量(101.3±16.6)mg、总用量(147.0±29.4)mg。S、D组体动反应分级低于C组,麻醉满意度评分优于C组(P<0.05)。C组呼吸抑制发生率(45%)高于D组(15%)(P<0.05)。S组咳嗽反射发生率(45%)高于D组(15%),差异有统计学意义(P<0.05)。结论地佐辛复合丙泊酚用于肝硬化患者胃镜检查,可减少丙泊酚用量,提高麻醉满意度,呼吸抑制轻,且不引起咳嗽反射,更适合于肝硬化患者内镜检查麻醉。

Objective To observe the safety and feasibility of dezocine combined with propofol in painless gastroscopy in patients with cirrhosis. Methods From June 2013 to June 2015, 60 patients with cirrhosis undergoing painless gastroscopy in our hospital were randomly divided into 3 groups, dezocine group（group D）, sufentanil group（group S） and control group（group C） with 20 cases in each. Dezocine 0.05 mg.kg-1, sufentanil 0.2 μg.kg-1 and normal saline 5 m L was administered intravenously in group D, group S, and group C, respectively. Then propofol was administered intravenously until enough anesthetic depth in all groups. The HR, MAP, and SPO2 were recorded at different time points. The gastroscopy time, recovery time, induction and total dosage of propofol, grade of body movement, level of satisfaction with the anesthesia and incidence of intraoperative adverse events were recorded, too. Results The induction dosage of propofol was（85.5 ±10.6） mg,（87.3±10.7） mg,（101.3±16.6） mg respectively in group S, group D, and group C, which showed that the induction dosage of propofol was much less in group S, group D than that in group C. The total dosage of propofol was（121.2±20.3） mg,（127.5±17.6） mg, and（147.0±29.4） mg respectively in group S, group D, and group C, which showed that the total dosage of propofol was much less in group S, group D than that in group C. Compared with group C, the grade of body movement was lower in group D and group S（P〈0.05）; but the level of satisfaction with anesthesia was higher in group D and group S（P〈0.05）.The incidence of respiratory depression in group C was higher than that in group D（45% vs 15%）（P〈0.05）. The incidence of cough reflex was higher in group S than that in group D（45% vs 15%）（P〈0.05）. Conclusion Application of dezocine combined with propofol in painless gastroscopy in patients with cirrhosis can reduce the used dosage of propofol, and improve the level of satisfaction with anesthesia with light respiratory depression and no cough reflex, so it is more suitable for patients with cirrhosis undergoing painless gastroscopy.