瑞芬太尼靶控输注在过度肥胖患者无痛胃镜检查中的应用

Target-controlled Intravenous Analgesia with Remifentanil on Hyoxemia in Obese Patients with Painless Gastroscopy

目的探讨瑞芬太尼靶控输注在过度肥胖患者无痛胃镜检查中的应用效果和安全性。方法选取拟行无痛胃镜检查的过度肥胖患者100例,采用数字表法将其随机分为两组(n=50):瑞芬太尼靶控组(R组)和空白对照组(N组)。R组:采用靶控输注瑞芬太尼,血浆靶浓度为2ng/ml;N组:泵注同等容积的生理盐水。记录给药前(T_0)、检查开始时(T_1)、胃镜过声门时(T_2)、检查结束时(T_3)及术后5min(T4)的心率(HR)、血压(MAP)、呼吸频率(RR)。用Ramsay评分评价术中镇静作用;记录手术胃镜检查时间及术中低氧血症、体动反应、呼吸暂停、心动过缓和低血压等并发症的发生情况。记录两组患者、麻醉医生及内镜医生的满意度。结果与N组相比,R组患者T_1、T_2、T_3时HR、MAP,及术中体动反应发生率明显降低(P<0.05),患者及内镜医生满意度明显增高(P<0.05)。结论瑞芬太尼靶控输注可在肥胖患者无痛胃镜检查中可产生良好的镇痛、镇静效果,是一种安全、有效的麻醉方法,值得临床推广。

Objective To explor the safly and the effect of controlled intravenous analgesia with remifentanil on hyoxemia in obese patients with painless gastroseopy. Methods One hundred patients undergoing painless gastroseopy were randomly and equally allocated into 2 groups （50 each）. In group R, anesthesia was induced with TCI （target - controlled infusion） of remifentanil, and the target plasma concentration （Cp） of propofol was set at 2ng/ml. In group N,the same volume of saline was continues infusion. MAP, RR and HR were monitored and recorded before the examination（TO ） ,the time point of examination start（T1 ）, gastroseopy go through glottis （T2 ）, at the end of the operation （T3 ） and 5 min after examination （ T4 ）. The effect of sedation was evaluated by Ramsay. Except that, gastroscopy time, the satisfaction of patient,anesthetist and endoscopist were reeored. In addition, apnea, bradycardia,hypoxemia, myoclonus, body movement,hypotension and postoperative complications were also recorded. Results Compared with group N, in group R,HR,MAP and rate of body movement were significantly decreased （ P 〈 0.05 ）. Except that, the satisfaction of patient and endoscopist were increased （P 〈 0.05）. Conclusion TCI of remifentanil can provide satisfaction sedation for obese patients with painless gastroscopy with few adverse effects.