不同剂量瑞芬太尼并丙泊酚靶控输注行无痛胃镜检查对冠心病患者循环稳定及心肌的影响

Influence of Various Doses of Remifentanil Combined with Propofol Target Controlled Infusion on Circulatory Stability and Myocardial Damage in Patients with Coronary Heart Disease Undergoing Painless Gastroscopy

目的探讨不同剂量瑞芬太尼并丙泊酚靶控输注行无痛胃镜检查对冠心病患者循环稳定及心肌损伤的影响。方法选取在我院接受无痛胃镜检查的冠心病70例,随机分为对照组与观察组,每组各35例。对照组予0.2μg/kg瑞芬太尼+丙泊酚靶控输注,观察组予0.6μg/kg瑞芬太尼+丙泊酚靶控输注,观察麻醉相关指标、循环相关指标及心肌酶谱变化。结果观察组睫毛反射消失时间、检查时间均短于对照组,差异有统计学意义(P<0.05)。与本组检查前比较,两组检查中收缩压(SBP)、舒张压(DBP)、心率(HR)、呼吸(RR)均升高,差异有统计学意义(P<0.05);与对照组比较,观察组检查中SBP、DBP、HR、RR水平降低,差异有统计学意义(P<0.05)。与本组检查前比较,对照组检查结束即刻乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)、天冬氨酸转氨酶(AST)水平升高,差异有统计学意义(P<0.05);与对照组比较,观察组检查结束即刻LDH、CK-MB、CK、AST水平显著降低,差异有统计学意义(P<0.05)。结论高剂量瑞芬太尼并丙泊酚靶控输注可减少冠心病患者无痛胃镜检查中的循环波动,保护心肌细胞。

Objective To study the effect of various doses of Remifentanil combined with Propofol target controlled infusion on circulatory stability and myocardial damage in patients with coronary heart disease(CHD)undergoing painless gastroscopy.Methods Seventy patients with CHD admitted to our hospital from May 2013 to January 2017 were randomly divided into control group(n=35)and observation group(n=35).Patients in control group underwent 0.2 g/kg Remifentanil+Propofol target controlled infusion,whereas those in observation group received 0.6 g/kg Remifentanil+Propofol TCI.Aesthetic-related indices,circulation-related indices and changes in myocardial enzyme spectrum in two groups were compared.Results Both eyelash reflex time and inspection time were significantly shorter in observation group than in control group(P<0.05),SBP,DBP,HR and RR in two groups were higher in both groups,as compared those prior to gastroscopy,and differences were statistically significant(P<0.05).By contrast,SBP,DBP,HR and RR in observation group were lower,showing significant differences(P<0.05).Immediately after gastroscopy,serum LDH,CK-MB,CK and AST were significantly higher in control group(P<0.05),whereas those in observation group were notably lower than in control group(P<0.05),as compared with those before gastroscopy.Conclusion High-dose Remifentanil combined with Propofol target controlled infusion can reduce the circulatory fluctuation in CHD patients undergoing painless gastroscopy,and play a role in the protection of myocardial cells.