纳布啡或芬太尼联合丙泊酚麻醉用于内镜超声检查术麻醉效果的比较

Comparison of anesthetic effects of nalbuphine or fentanyl combined with propofol for endoscopic ultrasonography

目的:比较纳布啡或芬太尼联合丙泊酚麻醉用于内镜超声检查术(endoscopic ultrasonography,EUS)的安全性及效果。方法:选择EUS患者100例,ASA分级I或II级,性别不限,年龄18~70岁,体重45~80 kg。采用随机数字表法,将其分为芬太尼联合丙泊酚组(F组)与纳布啡联合丙泊酚组(N组),每组50例。2组分别静脉注射芬太尼1μg/kg(F组)、纳布啡0.1 mg/kg(N组),随后静脉注射丙泊酚1~2 mg/kg,待睫毛反射消失后开始插入内镜,检查过程中如出现体动,酌情追加丙泊酚0.2~0.5 mg/kg。比较诊疗操作时间、麻醉苏醒时间、清醒时间、术中心血管不良事件、呛咳、呼吸抑制及术后恶心呕吐发生情况及丙泊酚用量。结果:2组患者诊疗操作时间差异无统计学意义(P>0.05);与F组比较,N组患者麻醉苏醒时间、清醒时间缩短,心血管不良事件和呛咳发生率降低,呼吸抑制和术后恶心呕吐的发生率降低,且程度减轻,丙泊酚用量减少(P<0.05)。结论:纳布啡联合丙泊酚麻醉用于内镜超声检查具有血流动力学稳定,呼吸抑制轻,术中及术后并发症少的优点,可安全有效地应用于EUS,其效果优于芬太尼联合丙泊酚麻醉。

Objective:To compare the safety and efficacy of nalbuphine combined with propofol and fentanyl combined with propofol in patients undergoing endoscopic ultrasonography(EUS).Methods:A total of 100 patients of both sexes,aged 18–70 years,weighing 45–80 kg,of ASA physical status I or II,undergoing EUS were included in this study and randomly assigned to 2 groups(n=50 for each):a nalbuphine plus propofol(group N)or a general anesthesia(Fentanyl plus propofol,group F).The study protocol was approved by the institutional review board for human investigation of our hospital.In group F,fentanyl and propofol were administered according to following protocol:1μg/kg fentanyl was injected,and then 1–2 mg/kg propofol was given peripheral intravenously.The anesthesia was induced in group N with a similar manner:0.1 mg/kg nalbuphine was injected and 1–2 mg/kg propofol were used.While body movement was observed during the endoscopic procedure,0.2–0.5 mg/kg propofol was added.Outcomes measured included time of operation time,wake-up time,recovery time,occurrence of adverse cardiovascular events,bucking,nausea and vomiting and respiratory depression.The amount of propofol consumed was recorded.Results:No statistical difference was observed in time of operation time between the two groups.But,wake-up time,recovery time,adverse cardiovascular events,the incidence of bucking,the incidence and the degree of nausea and vomiting and respiratory depression,and amount of propofol consumed were significantly decreased in group N,compared with group F.Conclusion:A combination of nalbuphine and propofol is a better and safer way to induce anesthesia for patients undergoing EUS than fentanyl combined with propofol.It shows more stable hemodynamics,less respiratory inhibition,and fewer complications during and after EUS.