七氟烷吸入浓度递减法与丙泊酚-瑞芬太尼分步靶控输注对老年患者无痛结肠镜检查的效果比较

Decreasing sevoflurane inhalation concentration versus propofol-remifentanil step-by-step target controlled infusion for elderly patients with painless colonoscopy

目的比较七氟烷吸入浓度递减法与丙泊酚-瑞芬太尼分步靶控输注对老年患者无痛结肠镜检查的效果。方法选取拟行无痛结肠镜检查的患者160例。采用随机数字表法将其分为S组(吸入七氟烷)与P组(丙泊酚-瑞芬太尼靶控输注),每组80例。S组采用浓度递减法进行面罩吸入七氟烷;P组采用丙泊酚-瑞芬太尼分步靶控输注法。记录结肠镜检查过程中及各时点收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PetCO2)和脑电双频谱指数(BIS);记录诱导时间、结肠镜检查时间、苏醒时间及离开麻醉恢复室的时间;记录结肠镜检查中低氧血症、体动反应情况及相关不良事件发生情况;记录苏醒期恶心、呕吐、躁动、寒战及结肠镜检查后腹痛的发生情况。结果与S组比较,P组麻醉诱导时间显著缩短,苏醒期恶心、呕吐、躁动及结肠镜检查后腹痛的发生率显著更低(P <0. 05)。2组患者结肠镜检查前后各时点血流动力学指标、SpO2、PetCO2和BIS值及结肠镜检查时间、苏醒时间、寒战、体动反应分级比较差异均无统计学意义(P>0. 05)。结论与七氟烷吸入浓度递减法相比,丙泊酚-瑞芬太尼分步靶控输注法更适用于老年患者无痛结肠镜检查。

Objective To compare the effect of decreasing sevoflurane inhalation concentration and propofol-remifentanil step-by-step target controlled infusion for the elderly patients with painless colonoscopy.Methods One hundred and sixty patients who may undergo painless colonoscopy were divided into group S(sevoflurane inhalation,n=80)and group P(propofol-remifentanil target controlled infusion,n=80)according to random number table method.Group S was given decreasing anesthesia by mask inhalation of sevoflurane,while the group P was given propofol-remifentanil stepby-step target controlled infusion.Systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),pulse oxygen saturation(SpO2),end-tidal pressure of carbon dioxide(PetCO2),bispectral index(BIS)were recorded during colonoscopy and at different time points.The time of induction of anesthesia,length of colonoscopic examination time,awaken time,time to leave anesthesia recovery room were recorded.The occurrence of intraoperative hypoxemia,body reaction and adverse reactions were recorded.The incidence of agitation,nausea and vomiting,shivering,abdominal pain during awakening period,and abdominal pain after colonoscopy were recorded.Results Compared with group S,the time of induction of anesthesia was significantly shortened,the incidences of agitation,nausea and vomiting during awakening period,as well as abdominal pain after colonoscopy were significantly lower(P<0.05).However,no significant differences were found in hemodynamic index at different time points,SpO2,PetCO2,BIS before and after the colonoscopy,and in colonoscopy time,awakening time,incidence of shivering and body movement grading(P>0.05).Conclusion Propofolremifentanil step-by-step target controlled infusion is more suitable for painless colonoscopy in the elderly than the sevoflurane inhalation concentration reduction method.