不同镇痛药物联合丙泊酚静脉快通道麻醉用于无痛胃肠镜诊疗的临床观察

Clinical observation of different analgesics combined with propofol intravenous fast-track anesthesia for painless gastroenteroscopy

目的探讨不同镇痛药物(枸橼酸芬太尼、舒芬太尼及盐酸纳布啡)联合丙泊酚实施无痛胃肠镜检查的临床应用效果。方法选取我院2018年4~12月行无痛胃肠镜检查的患者90例,年龄20~70岁,体质量45~100kg,ASA分级Ⅰ或Ⅱ级,随机分为芬太尼组(F组,n=30)、舒芬太尼组(S组,n=30)及盐酸纳布啡组(N组,n=30)。各组以丙泊酚(1~2mg/kg)为镇静药物实施静脉快通道麻醉,F组选择静脉注射芬太尼(1μg/kg)为镇痛药物,S组选用舒芬太尼(0.1μg/kg),N组选用盐酸纳布啡(0.1mg/kg),术中酌情追加丙泊酚(0.5mg/kg)维持麻醉。观察患者术中体动、呼吸抑制、生命体征变化情况,记录苏醒时间、术后视觉模拟评分法(VAS)评分及不良反应发生情况。结果与F、S组相比,N组患者在无痛检查中呼吸抑制发生率明显降低,差异有统计学意义(P<0.05)。三组患者在丙泊酚用量、苏醒时间、术后VAS、镇静评分和术后不良反应发生率上比较,差异无统计学意义(P>0.05)。结论与芬太尼、舒芬太尼相比,门诊无痛胃肠镜检查中应用盐酸纳布啡更安全有效,值得推广。

Objective To investigate the clinical effect of different analgesics (fentanyl citrate,nalbuphine hydrochloride and sufentanil) combined with propofol on patients undergoing painless gastroenteroscopy.Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 20-70 years,weighing 45-100 kg,undergoing painless gastroenteroscopy,in the 942th Hospital of the PLA from April 2018 to December 2018 were selected and randomly divided into three groups ( n =30 each):fentanyl group (group F),sufentanil group (group S) and nalbuphine hydrochloride group (group N).Each group was given intravenous fast-track anesthesia with propofol (1-2 mg/kg) as sedative.Intravenous fentanyl (1 μg/kg) was used as an analgesic in group F,sufentanil (0.1 μg/kg) was used in group S,and nalbuphine hydrochloride (0.1 mg/kg) was used in group N,propofol (0.5 mg/kg) was added intraoperatively to maintain anesthesia as required.The changes of intraoperative body movement,respiratory depression and vital signs were observed,and the recovery time,postoperative VAS score and adverse reactions were recorded.Results Compared with group F and group S,the incidence of respiratory depression in group N was significantly reduced in painless examination,and the difference was statistically significant ( P <0.05).There were no statistically significant differences in propofol dosage,recovery time,postoperative VAS scores and incidence of postoperative adverse reactions among the three groups ( P >0.05).Conclusion Compared with sufentanil and fentanyl,nalbuphine hydrochloride is a safer and more effective analgesic for outpatients undergoing painless gastroenteroscopy,which is worthy of promotion.