靶控输注丙泊酚清醒镇静在食管静脉曲张套扎术中的应用

Target controlled infusion of propofol for conscious sedation in endoscopy variceal ligation

目的探讨靶控输注异丙酚复合芬太尼单次静注清醒镇静在肝硬化患者食管静脉曲张套扎术中的安全性及有效性。方法择期拟行食管静脉曲张套扎术的住院患者48例,随机分成清醒镇静(C)组和深度镇静(D)组,每组24例(n=24)。C组采用靶控输注丙泊酚实施清醒镇静,D组采用丙泊酚单次静注实施深度镇静,两组患者均在给予丙泊酚前静注芬太尼1μg/kg。术中采用警觉/镇静观察评分(OAA/S)和脑电双频指数(BIS)来评估镇静深度。观察并记录两组患者的血流动力学变化、不良反应发生情况、恢复时间以及内镜医师满意度和患者满意度。结果两组患者的一般资料无显著性差异。D组患者平均动脉压和心率的变化明显大于C组,呼吸抑制的发生率也高于C组(P<0.05)。C组的恢复时间(9.3±3.0)min明显短于D组(16.7±2.7)min(P<0.05);两组的内镜医师满意度评分无显著性差异(P>0.05);但在患者满意度评分方面,D组(9.3±0.6)分高于C组(7.9±0.7)分(P<0.05)。结论靶控输注异丙酚复合单次给予芬太尼清醒镇静能够安全有效的应用于肝硬化患者食管静脉曲张套扎术,且具有较好的心血管稳定性和较少的呼吸抑制。

Objective To evaluate the feasibility of conscious sedation using target controlled infusion of propofol combined with a single dose of fentanyl during endoscopic variceal ligation in patients with liver cirrhosis. Methods 48 patients with liver cirrhosis scheduled for endoscopic variceal ligation were randomly assigned to deep sedation group( group D) with intravenous bolus of propofol and conscious sedation group( C group) with target controlled infusion of propofol, 1 μg/kg fentanyl was intravenously injected in each patient before administration of propofol. Cardiorespiratory parameters were monitored, and the side-effects were recorded. The depth of sedation was assessed by both of the sale of observer′ s assessment of alertness/sedation( OAA/S) and the bispectral index( BIS). The quality of sedation/analgesia was evaluated by the endoscopist and patients using Visual Analog Score (VAS). The recovery level was evaluated with the Aldrete scale. Results No significant differences were found on demographic data and initial parameters in the two groups. Compared with the group C, the changes of mean arterial pressure(MAP) and heart rate(HR) and the signs of respiratory depression were significant in the group D( P < 0.05). The recovery time in group D(16.7±2.7)min was much longer than that in the group(9.3±3.0 min, P < 0.01). There was no difference in Visual Analogue Scale scores for endoscopist’s satisfaction between the two groups(9.2±0.6 vs . 9.0±0.6, P > 0.05),but a higher degree of satisfaction for patient was found in the group D( 9.3±0.6 vs.7.9±0.7,P <0.01). Conclusion Conscious sedation with TCI of propofol combined with a single bolus of fentanyl for endoscopic variceal ligation in patients with liver cirrhosis had better hemodynamic stability, less respiratory depression and shorter recovery time.