不同剂量纳洛酮对无痛肠镜麻醉苏醒质量及安全性的影响

Effect of different doses of naloxone on anesthesia,quality of recovery and safety in painless colonoscopy

目的探讨不同剂量纳洛酮对无痛肠镜检查麻醉苏醒质量以及安全性的影响。方法选取2014年2月至2015年1月于本院行无痛肠镜检查的100例患者为研究对象,随机分为高剂量组和低剂量组(每组各50例),两组均予芬太尼0.01 mg/kg,丙泊酚2 mg/kg进行麻醉。检查结束时高剂量组静脉推注纳洛酮14μg/kg,低剂量组静脉推注纳洛酮7μg/kg。比较两组患者检查后清醒时间、拔除导管时间、离开PACU时间、以及复苏期间各时间点MAP(平均动脉压)、HR(心率),检查后疼痛评分、情绪评分以及疼痛出现时间和并发症情况(呼吸抑制、恶心与呕吐)。结果检查后,高剂量组患者苏醒时间、拔除导管时间以及离开PACU时间和低剂量组患者比较,差异无统计学意义(P>0.05);低剂量组患者苏醒时、拔管时以及拔管后10 min的MAP以及HR均低于高剂量组患者MAP和HR,差异有统计学意义(P<0.05);两组患者疼痛评分、情绪评分以及出现疼痛时间比较,差异均无统计学意义(P>0.05);高剂量组患者呼吸抑制、恶心、呕吐发生率高于低剂量组,差异均有统计学意义(P<0.05)。结论与高剂量纳络酮相比,低剂量纳洛酮在无痛肠镜检查的促醒效果相当,且能够减少患者的呼吸抑制、恶心和呕吐等并发症,改善患者的MAP和HR,增强其安全性。

Objective To investigate the effect of different doses of naloxone on anesthesia,quality of recovery and safety in painless colonoscopy.Methods 100 patients who received painless colonoscopy in our hospital from February 2014 to January 2015 were recruited.Patients were randomly assigned to high-dose of naloxone group and low-dose of naloxone group,with 50 patients in each group.All patients received fentanyl（0.01 mg） and propofol（2 mg/kg）.At the end of examination,patients in the high-dose group received intravenous injection of naloxone of 14 ug/kg and those in the low-dose group received intravenous injection of naloxone of 7ug/kg.The following parameters were compared between the two groups： time to wake-up,time to extubation,time to leave the PACU,and MAP,HR,postoperative pain score,emotional score,time to recurrent pain and complications at each time point during the recovery.Results After examination,time to wake-up,time to removal of the catheter,and time to leave the PACU did not differ between the high-dose and low-dose group（P〉0.05）.MAR and HR in the low-dose group at the time of wake-up,extubation,and 10 mins after extubation were significantly lower than those in the high-dose group（P〈0.05）.There was no significant between-group difference in pain score,emotional score,and time to recurrent pain（P〉0.05）.Incidence of respiratory depression,nausea and vomiting was significantly higher in the high-dose group than in the low-dose group（P〈0.05）.Conclusion Low doses of naloxone can reduce the rate of nausea,vomiting,and respiratory depression.It can improve the patient＇s MAP and HR,and therefore increases the safety.It has good clinical effect.