小剂量瑞芬太尼复合丙泊酚麻醉用于老年患者无痛胃镜检查的临床观察

Low-Dose Remifentanil Combined with Propofol in the Anesthesia for the Elderly Undergoing Gastroscopy

目的评价小剂量瑞芬太尼和丙泊酚组合用于无痛胃镜麻醉的临床效果。方法选择ASAⅠ~Ⅱ级择期行胃镜检查的65~80岁之间老年患者134例,随机分为对照组(丙泊酚1~1.5 mg/kg)和观察组(瑞芬太尼15 g+丙泊酚1~1.5 mg/kg);根据2组患者体动反应追加30~50 mg丙泊酚。记录OAA/S 5级恢复时间、睁眼时间、低氧发生率(SpO2≤92%和≤85%)、起效时间、不良反应(呛咳,躁动,呃逆)的发生率,丙泊酚总量和胃镜检查时间,血压和心率。结果对照组65例,观察组69例患者入选。OAA/S 5级恢复时间和睁眼时间观察组短于对照组(P=0.011,P=0.031);丙泊酚总量和追加例数观察组少于对照组(P<0.001,=0.039)。胃镜检查时间、麻醉起效时间、低氧的发生率、不良反应发生率2组之间均无差别。2组患者术中心率和睫毛反射消失时的血压均低于其基础值(P<0.05,P<0.01)。结论小剂量瑞芬太尼联合丙泊酚用于无痛胃镜检查时优于单纯使用丙泊酚。

Objective To evaluate the clinical effect of low-dose remifentanil combined with propofol on the elderly undergoing gastroscopy.Methods 134 elderly with ASAⅠtoⅡfor selective gastroscopy(aged from 65 to 80 years old)were randomly divided into 2 groups:control group(=65)and treatment group(=69);propofol 1-1.5 mg/kg was given in the anesthesia of the elderly in control group while remifentanil 15 g combined with propofol 1-1.5 mg/kg in the anesthesia of the elderly in treatment group;propofol 30 to 50 mg was added according to the body movement of the cases;the OAA/S grade 5 recovery time,eye-opening time,hypoxia(SpO2≤92%and≤85%),anesthesia onset time,adverse reactions(cough,agitation and hiccup),propofol consumption,operation time length,heart rate and blood pressure during operation were observed and recorded.Results The OAA/S grade 5 recovery time and eye-opening time of the elderly in treatment group were significantly shorter than those in control group(P=0.011,P=0.031);the total propofol consumption of each case and the cases of propofol addition were significantly less in treatment group than those in control group(P<0.001,P=0.039);there was no statistical difference between the cases in the 2 groups in operation time length,anesthesia onset time,hypoxia rate and adverse reaction rate;the minimum heart rate in operation and the blood pressure at the time of eyelash reflex loss of the cases in both groups were lower than those of the baselines(P<0.05,P<0.01).Conclusions Low-dose remifentanil combined with propofol is superior to mere propofol in the anesthesia of the elderly undergoing gastroscopy.