瑞芬太尼与丙泊酚混合溶液自控镇痛镇静在老年患者肠镜检查中的应用

Patient-controlled Analgesia and Sedation with Remifentanil and Propofol for Colonoscopy in Elderly Patients

目的观察瑞芬太尼与丙泊酚混合溶液自控镇痛在老年患者结肠镜检查中的效果及不良反应,探讨其安全性及有效性。方法选取2015年5月-9月择期行无痛肠镜检查的老年患者60例,随机分为自控镇痛镇静（PCAS）组和静脉复合麻醉（TIVA）组,每组30例。PCAS组：接自控镇痛泵,负荷剂量设为0.05 m L/kg,继之以0.6 m L/（kg·h）的速度持续泵入丙泊酚与瑞芬太尼的混合药液,待负荷量输注完毕3 min后即可开始检查,术中患者根据自身感觉按压自控手柄,自控剂量为1 m L,锁定时间为1 min。TIVA组：静脉缓慢推注芬太尼1μg/kg,咪达唑仑0.02 mg/kg,2 min后缓慢推注丙泊酚0.8-1.0 mg/kg,待患者意识消失呼之不应即可开始检查。结果两组患者的平均血压在组内各时间点均较麻醉前下降,差异有统计学意义（P〈0.05）;TIVA组的平均血压下降比PCAS组更明显,差异有统计学意义（P〈0.05）。两组患者的心率、脉搏血氧饱和度及呼吸频率在组内各时间点均较麻醉前下降,差异有统计学意义（P〈0.05）;呼气末二氧化碳则较麻醉前升高,但组间比较差异均无统计学意义（P〉0.05）。两组患者的诱导时间、进镜至回盲部的时间以及总检查时间比较差异均无统计学意义（P〉0.05）,但从检查结束至OAA/S评分达5分和Aldrete评分达9分时间相比,PCAS组显著短于TIVA组,差异有统计学意义（P〈0.05）。结论瑞芬太尼与丙泊酚混合溶液用于PCAS较传统的静脉麻醉为老年患者提供更好的循环稳定性,麻醉恢复更迅速,可能成为老年患者肠镜检查的理想镇静镇痛方式。

Objective To evaluate the feasibility and efficiency of patient-controlled analgesia and sedation（PCAS） with propofol and remifentanil for colonoscopy in elderly patients.Methods Sixty elderly patients preparing for painless colonoscopy between May and September 2015 were randomly allocated into PCAS group and total intravenous anesthesia（TIVA） group with 30 patients in each.In the PCAS group,the mixture of remifentanil and propofol at0.6 mL/（kg ？ h） was pumped continuously after an initial bolus of 0.05 mL/kg mixture.The examination began three minutes after the infusion was finished.Patients could press the self-control button.Each bolus delivered1 mL and the lockout time was 1 minute.In the TIVA group,patients received fentanyl at 1 μg/kg and midazolam at0.02 mg/kg intravenously,and accepted intravenous propofol at 0.8-1.0 mg/kg two minutes later.The examination began when the patients lost consciousness.Results A significant decline of mean arterial blood pressure was detected within each group after anesthesia（P〈0.05）.The decrease of mean blood pressure in the TIVA group was more significant than that in the PCAS group（P〈0.05）.The heart rate,pulse oxygen saturation and respiratory rate decreased significantly after anesthesia in both the two groups（P〈0.05）,while end-tidal CO_2 increased after anesthesia without any significant difference between the two groups（P〈0.05）.The induction time,time to insert the colonoscope to ileocecus,and total examination time were not significantly different between the two groups（P〈0.05）.As for the time from the end of examination to OAA/S score of 5 and to Aldrete score of 9,the PCAS group was significantly shorter than the TIVA group（P〈0.05）.Conclusion PCAS with remifentanil and propofol can provide sufficient analgesia,better hemodynamic stability,lighter sedation,and faster recovery compared with TIVA.