丙泊酚分别复合盐酸纳布啡、地佐辛、舒芬太尼用于无痛胃镜的效果比较

Comparison of the Efficacy of Propofol Respectively Combined with Nalbuphine Hydrochloride,Dezocine and Fentanyl for Painless Gastroscopy

目的:比较丙泊酚分别复合盐酸纳布啡、地佐辛、舒芬太尼用于无痛胃镜的麻醉效果和安全性。方法:180例拟行无痛胃镜检查患者随机分为A组(60例)、B组(60例)和C组(60例)。所有患者术前禁食6 h、禁饮4 h,无麻醉前用药。入室后开放静脉,采用多功能心电监护仪监测收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO_2),同时静脉滴注0.9%氯化钠注射液,鼻导管吸氧3 L/min。在此基础上,A组患者静脉注射盐酸纳布啡注射液0.15 mg/kg+丙泊酚注射液1.5 mg/kg;B组患者静脉注射地佐辛注射液5 mg+丙泊酚注射液1.5 mg/kg;C组患者静脉注射舒芬太尼注射液5μg+丙泊酚注射液1.5 mg/kg。各组患者均根据体动、吞咽反射静脉追加20~30 mg丙泊酚注射液,维持一定的麻醉深度。观察各组患者麻醉前(T_0)、睫毛反射消失后(T_1)、置胃镜后(T_2)、苏醒时(T_3)的SBP、DBP、HR、SpO_2,苏醒时间、离院时间,麻醉前后简易智能精神状态检查量表(MMSE)评分及不良反应发生情况。结果:各组患者T_1-3时的SBP、DBP、HR、SpO_2均显著低于同组T_0时,且T_1时C组SpO_2低于A、B组,差异均有统计学意义(P<0.05);T_(1-3)时上述指标各组间比较,差异均无统计学意义(P>0.05)。A组患者离院时间显著短于B组,差异有统计学意义(P<0.05),A、C组间,B、C组间比较差异无统计学意义(P>0.05)。A组患者术中呛咳率、术后恶心呕吐发生率显著低于B、C组,差异均有统计学意义(P<0.05),B、C组间比较差异无统计学意义(P>0.05);A、C组患者术后头晕、嗜睡发生率均显著低于B组,差异均有统计学意义(P<0.05),A、C组间比较差异无统计学意义;各组患者术中体动发生率比较,差异无统计学意义(P>0.05)。各组患者苏醒时间、麻醉前后MMSE评分比较,差异均无统计学意义(P>0.05)。结论:丙泊酚复合盐酸纳布啡用于无痛胃镜的麻醉效果和安全性均优于地佐辛、舒芬太尼。

OBJECTIVE： To compare the anesthetic effect and safety of propofol respectively combined with nalbuphine hydro- chloride, dezocine or fentanyl for painless gastroscopy. METHODS： 180 patients undergoing painless gastroscopy were randomly divided into group A （60 cases）, group B （60 cases） and group C （60 cases）. All patients forbidden to eat 6 h and drink 4 h be- fore surgery, no premedication. Opening veins after entering the room, multi-function ECG monitor was used to monitor the systol- ic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR）, pulse oxygen saturation （SpOt,）, intravenously infused 0.9% Sodium chloride injection, oxygen inhalation for 3 L/min by nasal catheter. Based on it, group A intravenously injected Nalbu- phine hydrochloride injection 0.15 mg/kg＋Propofol injection 1.5 mg/kg; group B intravenously injected Dexorcin injection 5 mg＋ Propofol injection 1.5 mg/kg; group C intravenously injected Sufentanil injection 5 μg＋Propofol injection 1.5 mg/kg. According to patients＇ body movement and swallowing reflex, all patients added 20-30 mg Propofol injection to maintain the depth of anesthesia. SBP, DBP, HR and SpO： before anesthesia （To）, after eyelash reflex disappeared （T1）, after placing gastroscopy （T2） and when came to senses （T3）, awakening time and discharge time, MMSE score before and after anesthesia, and the incidence of adverse re- actions in each group were observed. RESULTS： The SBP, DBP, HR and SpO2 in each group at T1.3 were significantly lower than To, SpO2 at T1 in group C was lower than group A and group B, with statistical significances （P〈0.05）, while there was no signif- icant difference in group A and group B. There were no significant differences the above-mentioned indexes in each group at T1-3 （P〉0.05）. The discharge time in group A was significantly shorter than group B, with statistical significance （P〉0.05）, there was no significant difference in group A and group C, group B and group C （P〉0.05）. The intraoperative cough rate and inci- dence postoperative nausea and vomiting in group A were significantly lower than group B and group C, with statistical significanc- es （P〈0.05）, while there was no significant difference in group B and group C （P〉0.05）; the incidences of dizziness and drowsi- ness in group A and group C were significantly lower than group B, with statistical significances （P〈0.05）, there was no signifi- cant difference in group A and group C （P〉0.05）, and there was no significant difference in the incidence of intraoperative body movement in each group（P〉0.05）. And there was no significant differences in awaking time and the MMSE scores before and af- ter anesthesia in each group （P〉0.05）. CONCLUSIONS： Propofol combined with nalbuphine has better anesthetic effect and safe- ty than dexorcin and sufentanil for painless gastroscopy.