丙泊酚与不同阿片类药物配伍应用于门急诊无痛胃镜检查的麻醉效果和满意度比较

Comparison of anesthetic effect and satisfaction of propofol and its combination with different opioids in painless gastrointestinal endoscopy

目的通过丙泊酚及其复合3种不同阿片类药物在无痛胃镜麻醉中效果及满意度的对比研究,探讨更安全有效的麻醉用药方案。方法选择2018年11月至2019年2月期间行无痛胃镜检查的美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ级门急诊患者385例,利用随机数字法将患者分成四组:丙泊酚复合0.9%氯化钠溶液组(A组,97例)、丙泊酚复合芬太尼组(B组,95例)、丙泊酚复合舒芬太尼组(C组,98例)、丙泊酚复合瑞芬太尼组(D组,95例),比较四组患者的术前、术中不同时间点生命体征变化、苏醒时间、离院时间、丙泊酚总用量、患者和手术者对麻醉的满意度、不良反应发生率。结果①生命体征变化:四组患者组间比较,经皮动脉血氧饱和度[(percutaneous arterial oxygen saturation)以SpO2表示]在胃镜检查开始即刻(T1)D组显著低于其他三组,差异有统计学意义(P<0.05)。四组患者组内比较平均血压(mean blood pressure,MBP)、心率、SpO2均在T1时间点出现下降,差异有统计学意义(P<0.05)。②苏醒时间、离院时间及丙泊酚用量比较:A组苏醒时间、离院时间均明显长于B、C、D组(P<0.05),C组离院时间明显短于B、D组(P<0.05);A组丙泊酚用量最大,D次之,A和B、C、D组分别比较差异有统计学意义(P<0.05),D组分别与B、C组比较,差异均有统计学意义(P<0.05)。③患者满意度比较:A组满意度较低,分别同B、C、D组比较,差异均有统计学意义(P<0.05)。C组满意度评分最高,分别与B、D组比较,差异有统计学意义(P<0.05)。④手术医师满意度比较:C组手术医师满意度较高,A组和C组间差异有统计学意义(P<0.05),其余各组之间两两比较差异无统计学意义。⑤不良反应发生率比较:A组不良反应中低血压发生率较高,与其余三组相比差异有统计学意义(P<0.05)。结论结合术中生命体征变化、苏醒时间、离院时间、术中不良反应发生率、患者及手术医师对麻醉满意度等方面,丙泊酚复合舒芬太尼用于无痛胃镜检查的离院时间短、麻醉效果好、术中生命体征较平稳、麻醉效果较满意、安全性较高,体现了该药物组合的合理性及其相关效益,是无痛胃镜检查较佳的麻醉药物配伍。

Objective To explore a more safe and ideal anesthesia method through the comparative study of the anesthesia effect and satisfaction between propofol and its combination of three different opioids in painless gastrointestinal endoscopy.Methods The data of 385 ASAⅠ~Ⅱpatients who underwent painless gastrointestinal endoscopy were selected and randomly divided into four groups by SPSS software:propofol compound physiological salt(group A,n=97),propofol compound fentanyl(group B,n=95),propofol compound sufentanil(group C,n=98),propofol combined with remifentanil(group D,n=95).The changes of vital signs before and during operation,recovery time,discharge time,total dosage of propofol,satisfaction with anesthesia of surgeon and patients and the side effect were compared between the four groups.Results Percutaneous oxygen saturation(SpO2)was significantly lower in group D than that in the other three groups at the beginning of the gastrointestinal endoscopy(T1)and the difference was statistically significant(P<0.05).Mean blood pressure(MBP),heart rate(HR),and SpO2 of the four groups were all decreased at T1,and the difference was statistically significant(P<0.05).The observation of the recovery time,discharge time and total propofol dosage of the four groups revealed that the recovery time of group A was longer than that of group B,C and D(P<0.05),but there was no significant difference among group B,C and D(P>0.05).The time of discharge in group A was significantly longer than that in other three groups(P<0.05),and the time of discharge in group C was significantly shorter than that in group B and D(P<0.05).The total dosage of propofol in group A was the largest,and there were significant differences between group A and group B,C and D(P<0.05).The total dosage of propofol in group D was significantly larger than that in group B and C(P<0.05).Patient satisfaction in group A was the lowest,and there were significant differences between group A and group B,C and D(P<0.05),while patient satisfaction in group C was significantly higher than that in group B and D(P<0.05).The satisfaction of surgeons in group C was relatively high,and there was a statistically significant difference between group A and Group C(P<0.05),while pairwise comparisons between the other groups showed no statistically significant differences.The percentage of hypotension in group A was higher and the difference was statistically significant compared with the other three groups(P<0.05).Conclusion Sufentanil combined with propofol has the advantages of short discharge time,good anesthetic effect,stable vital signs during operation and high satisfaction in patients and surgeons.It is a reasonable and feasible combination of anesthetic drugs in painless gastrointestinal endoscopy.