丙泊酚复合阿片类药物在无痛结肠镜检查中的应用

Application of Propofol Combined with Opioids in Painless Colonoscopy

目的探讨丙泊酚复合阿片类药物与单纯应用丙泊酚维持用于结肠镜检查的临床效果。方法选取行无痛结肠镜检查的患者215例,年龄18~55岁,ASAⅠ或Ⅱ级,随机分为3组：芬太尼复合丙泊酚组（F组,n=72）、地佐辛复合丙泊酚组（D组,n=71例）和单纯丙泊酚组（C组,n=72例）。F组静脉注射芬太尼50μg,丙泊酚1~2mg/kg;D组静脉注射地佐辛5mg,丙泊酚1~2mg/kg;C组注射与F组、D组相同容量的生理盐水,丙泊酚1~2mg/kg。3组均静注丙泊酚2~4mg·kg-1·h-1维持一定的麻醉深度。记录3组患者麻醉诱导前（T0）、诱导后2min（T1）、结肠镜过肝曲时（T2）、镜检结束时（T3）的心率（HR）、收缩压（SBP）、脉搏氧饱和度（SpO_2）,记录3组患者的意识消失时间、结肠镜检查时间、苏醒时间、丙泊酚总量及不良反应发生情况。结果与T_0相比,T_1,T_2时3组HR明显减弱,SBP,SpO_2明显降低（P〈0.05）;T1时D组SpO_2明显高于F组、C组（P〈0.05）,且F组高于C组（P〈0.05）。3组意识消失时间、结肠镜检查时间差异无统计学意义。C组术毕苏醒时间、丙泊酚用量均多于F组、D组（P〈0.05）,而F组、D组差异无统计学意义。C组不良反应例数明显多于F组、D组（P〈0.05）,其中D组最少。结论丙泊酚复合阿片类药物行无痛肠镜检查有助于减轻单独应用引起的不良反应,安全有效,与丙泊酚复合芬太尼比较,地佐辛的呼吸抑制作用明显弱于芬太尼,在麻醉安全和麻醉管理方面更具优势。

Objective To study the clinical effect of propofol combined with opioid drugs and simple application of propofol in the maintenance of colonoscopy. Methods A total of 215 cases of patients with painless colonoscopy were selected, ranging from 18 to 55 years old, ASA I or Ⅱ. The patients were randomly divided into three groups ：fetanyl group（ group F ,50μg fentanyl plus 1 ~ 2mg/kg propo- fol,n =72） ,dezoeine group（ group D,5mg dezocine plus 1 ~ 2mg/kg propofol,n =71） and control group（ group C,normal saline plus 1 - 2mg/kg propofol,n =72 } ,anesthesia was maintainded with propofol 2 -4mg · kg-1 · h-1 during the surgery. HR,SpO2 ,SBP in baseline （ T0） ,2rain -after induction of anethesia（ Tl ） ,mirror over the hepatic flexure of colon（ T2 ） and checking ending（ T3 ） were recorded. In addi- tion, the time of loss of consciousness, checking time, recovery time, the total amount of propofol and the adverse reactions were also observed. Results Compared with To , HR, SpO2 , SBP at T1 in all the groups were significantly decreased （ P 〈 0.05 ）. SpO2 in group D were signifi- cantly higher than in group F and group C, and SpO2 in group F was higher than in group C （ P 〈 0.05 ）. Among three groups, there was no statistical significance in checking time and recovery time. Compared with the group C, the total amount of propofol and recovery time were significantly decreased in group F and group D, but there was no statistical significance betweem group F and group D. The incidences of ad- verse reactions in group C were higher than those in group F and group D, especially in group D （ P 〈 0.05 }. Conclusion Propofol in combi-nation with opioids for sedation during painless colonoscopy can alleviate adverse reactions caused by propofol alone. Compared with propofol combined with fentanyl, respiration depression is dramaticlly lower in propofol combined with dezocine, therefore dezocine has a clear advan- tage in anesthesia security and management.