预输液体对无痛肠镜检查过程中血流动力学的影响

Effect of pre-delivery fluid on hemodynamics during painless enteroscopy

目的观察预输液对无痛肠镜检查过程中血流动力学的影响。方法选择ASAⅠ—Ⅲ级需做无痛肠镜检查的患者100例,按随机数字表法分为预输液组(Ⅰ组)和对照组(Ⅱ组),每组50例;Ⅰ组在检查前预输入乳酸钠林格氏液10 mL/kg,Ⅱ组不输任何液体,监测血压、心率(HR)、心电图、血氧饱和度(SpO 2),面罩吸氧4~6 L/min,静脉推注丙泊酚和瑞芬太尼混合液,首次缓慢推入丙泊酚的量为1.5~2 mg/kg,患者睫毛反射消失后肠镜检查,术中出现体动时静脉追加丙泊酚混合液2~3 mL,退镜时停注麻醉药。观察指标:推药前(T 0)、推药后即刻(T 1)、推药后4 min(T 2)、结束时(T 3),苏醒(呼之能睁眼)时(T 4)的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、HR、SpO 2,苏醒后的恶心呕吐、头晕等情况。结果与T 0时比较,T 1、T 2、T 3、T 4时两组SBP、DBP、MAP、HR均明显降低(P<0.05)。与Ⅱ组比较,T 1、T 2、T 3、T 4时Ⅰ组SBP、DBP、MAP均明显高于Ⅱ组,HR慢于Ⅱ组(P<0.05);Ⅰ组低血压、恶心呕吐、头晕发生率明显低于Ⅱ组(P<0.05)。结论预输入乳酸钠林格氏液10 mL/kg,患者无痛肠镜检查过程中血流动力学更加稳定,苏醒后恶心呕吐发生率更低。

Objective To observe the effect of pre-infusion on hemodynamics during painless colonoscopy.Methods A total of 100 patients with ASAⅠ-Ⅲwho needed painless colonoscopy were randomly divided into two groups:pre-infusion group(Ⅰ)and control group(Ⅱ),and there were 50 patients in each group.In groupⅠ,sodium lactate Ringer's solution was pre-infused with 10ml/kg,and groupⅡwas not infused with any liquid.Then BP,HR,ECG,SpO 2 were monitored;mask oxygen uptake was 4-6 L/min;propofol and remifentanil mixture were injected intravenously;the amount of propofol was 1.5-2 mg/kg for the first time,and intestinal microscopic examination was performed after the eyelash reflex disappeared.In the procedure,2-3 mL of propofol mixed solution was added to the vein,and the anesthetic was stopped at the time of returning.Observation indicators included SBP,DBP,MAP,HR,SpO 2[Before pushing medicine(T 0),immediately after the drug(T 1),4 min after the administration(T 2),at the end(T 3),waking up(Shouting can open eyes)(T 4)],and the nausea,vomiting,dizziness after waking.Results Compared with T0,at T1,T2,T3,T4,SBP,DBP,MAP significantly decreased in both groups(P<0.05).Compared with groupⅡ,SBP,DBP,MAP,HR in group I were significantly higher than those in groupⅡ;HR in group I was slower than that in groupⅡ,and the incidence of hypotension,nausea,vomiting and dizziness in groupⅠwas significantly lower than that in groupⅡ(P<0.05),and the incidence of hypotension,nausea,vomiting and dizziness in groupⅠwas significantly lower than that in groupⅡ(P<0.05).Conclusion The blood flow dynamics is more stable in the process of painless enteroscopy,and the incidence of nausea and vomiting after recovery is lower with 10 mL/kg of Ringer's solution pre-infusion.