高剂量瑞芬太尼对冠心病无痛胃镜检查患者循环系统及cTnI、BNP的影响

Effect of High Dose Remifentanil on Circulatory System and cTnI,BNP in Coronary Heart Disease Patients with Painless Gastroscopy

本文旨在探讨高剂量瑞芬太尼对冠心病无痛胃镜检查患者循环系统及心肌损伤的影响。无痛胃镜检查的冠心病患者96例随机分为LR组(丙泊酚+瑞芬太尼0.2μg·kg^-1,n=48)和HR组(丙泊酚+瑞芬太尼0.5μg·kg^-1,n=48)。比较2组睫毛反射消失时间、胃镜检查时间、苏醒时间及丙泊酚用量,观察检查前(T 0)、检查开始即刻(T 1)、检查开始后5 min(T 2)、10 min(T 3)、检查结束即刻(T 4)SBP、HR、RPP及ST段、T波变化,并检测2组胃镜检查前和结束时cTnI、BNP等指标。结果显示,HR组睫毛反射消失时间、胃镜检查时间、丙泊酚用量低于LR组(P<0.05);T 3、T 4时HR组SBP、HR及RPP低于LR组(P<0.05);HR组T1、T2时ST段与T波改善情况优于LR组(P<0.05);HR组检查后cTnI、BNP水平低于LR组(P<0.05);HR组术中一般体动反应发生率低于LR组(P<0.05)。表明0.5μg·kg^-1瑞芬太尼复合丙泊酚用于冠心病无痛胃镜检查麻醉效果满意,对患者循环系统及cTnI、BNP的影响较小。

The purpose of this study was to investigate the effects of high dose remifentanil on the circulatory system and myocardial injury indexes in coronary heart disease patients with painless gastroscopy.96 coronary heart disease patients with painless gastroscopy were divided randomly into group LR(propofol+remifentanil 0.2μg·kg^-1,n=48)and group HR(propofol+remifentanil 0.5μg·kg^-1,n=48).Disappearance time of eyelash reflex,gastroscopy examination time,recovery time and propofol dosage were compared between the two groups.The changes of SBP,HR,RPP,ST segment and T wave in the two groups were observed before examination(T 0),at the beginning of examination(T 1),5 min after examination(T 2),10 min after examination(T 3),and immediately after examination(T 4).The plasma levels of cTnI,BNP before and after gastroscopy examination were detected in the two groups.The results showed that the disappearance time of eyelash reflex,gastroscopy examination time and propofol dosage in group HR were lower than those in group LR(P<0.05).SBP,HR and RPP at T 3,T 4 in group HR were lower than those in group LR(P<0.05).The improvement of ST and T waves at T 1,T 2 in group HR was better than that in group LR(P<0.05).The levels of cTnI,BNP after the examination in group HR were lower than those in group LR(P<0.05).The incidence of intraoperative general somatic reaction in group HR was lower than that in group LR(P<0.05).The results indicate that the anesthesia effect of 0.5μg·kg^-1 remifentanil combined with propofol in coronary heart disease patients with painless gastroscopy is satisfied,the impact on the patient's circulatory system and cTnI、BNP is small.