基于不同体质量分类使用丙泊酚麻醉效果比较

Comparison on the effects of Propofol injection based on different body mass in elderly obese patients undering painless colonoscopy

目的比较丙泊酚基于去脂体质量、总体质量的2种不同诱导剂量对行无痛肠镜检查的老年肥胖患者麻醉效果。方法选择行择期无痛肠镜检查的患者56例,年龄65~80岁,美国麻醉医师学会(ASA)分级为Ⅰ~Ⅱ级,根据体质指数(25 kg/m^(2))分为正常体质量和肥胖,将正常体质量分为按去脂体质量给药组(正常去脂组)和按总体质量给药组(正常总体质量组);肥胖分为按去脂体质量给药组(肥胖去脂组)和按总体质量给药组(肥胖总体质量组),每组均为14例。记录患者诱导所需丙泊酚诱导用量、追加量、苏醒时间和不良反应。结果正常去脂组和正常总体质量组丙泊酚诱导用量、总用量、苏醒时间、不良反应发生率没有明显差异;肥胖去脂组丙泊酚诱导用量低于肥胖总体质量组[分别为(80.3±6.2)mg和(86.3±5.8)mg,P<0.05],总用量[分别为(113.1±14.5)mg和(117.4±11.4)mg]和苏醒时间[分别为(1.6±0.5)min和(1.9±0.6)min]差异均无统计学意义(均P>0.05),肥胖去脂组低血压发生率明显低于肥胖总体质量组[分别为7.1%和42.9%,P<0.05]。结论对老年肥胖患者行无痛肠镜检查麻醉时,丙泊酚诱导按去脂体质量给药,能降低肠镜检查过程中低血压的发生率。

Objective To compare the anesthesia effect of two different induction doses of Propofol on elderly morbid obesity patients undergoing painless colonoscopy. Methods Fifty-six patients aged 65-80 undergoing elective painless colonoscopy were selected. They were divided into normal weight group and obesity group according to the American Society of anesthesiologists(ASA)grade Ⅰ-Ⅱ. The normal weight group was divided into NL group(according to lean body weight)and NT group(according to the total body weight);the obesity group was divided into OL group(according to lean body weight)and OT group(according to the total body weight),with 14 cases in each group. The dosage of Propofol induction,additional dosage,recovery time and adverse reactions were recorded. Results There was no significant difference between NL group and NT group in the dosage of Propofol induction,total dosage,recovery time and incidence of adverse reactions. The dosage of Propofol induction in OL group was lower than that in OT group[(80. 3±6. 2)mg vs.(86. 3±5. 8)mg,P<0. 05]. There was no significant difference in total dosage[(113. 1±14. 5)mg vs.(117. 4±11. 4)mg],recovery time[(1. 6±0. 5)min vs.(1. 9±0. 6)min](all P>0. 05). The incidence of hypotension in OL group was significantly lower than that in OT group(7. 1%vs. 42. 9%,P<0. 05). Conclusion Propofol administration based on lean body weight can reduce the incidence of hypotension during painless colonscopy in elderly obese patients.