不同剂量阿芬太尼复合丙泊酚用于无痛胃镜检查的效果

Effects of different doses of alfentanil combined with propofol on painless gastroscopy

目的观察不同剂量阿芬太尼复合丙泊酚用于无痛胃镜的效果,探讨阿芬太尼复合丙泊酚用于无痛胃镜时的最佳剂量。方法选择2020年11月至2021年1月行无痛胃镜检查患者200例,男87例,女113例,年龄18~60岁,BMI 18~28 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为四组:阿芬太尼3μg/kg组(A3组)、阿芬太尼5μg/kg组(A5组)、阿芬太尼7μg/kg组(A7组)和阿芬太尼9μg/kg组(A9组),每组50例。四组分别于入室吸氧3 min后缓慢静脉注射阿芬太尼3、5、7、9μg/kg。1 min后静脉注射丙泊酚2 mg/kg,给药完成后即刻评估改良警觉/镇静评分(MOAA/S评分),之后每30秒进行一次评估,直至MOAA/S评分≤3分时开始进镜操作。若进镜失败或给药后2 min MOAA/S评分仍≥4分,则追加丙泊酚0.5 mg/kg,直至受试者MOAA/S评分≤3分,每次追加药物间隔时间≥1 min。记录首次诱导成功例数、麻醉诱导时间、苏醒时间、达离院标准时间。记录注药前1 min(T_(1))、进镜操作即刻(T_(2))、操作开始即刻(T_(3))、操作开始后1 min(T_(4))、操作结束即刻(T_(5))的HR、SBP、DBP、SpO_(2)、RR。记录丙泊酚追加例数以及患者、检查医师、麻醉科医师满意情况。记录注射痛、操作中不良事件(体动反应、呼吸抑制及低血压)的发生情况。结果与T_(1)时比较,T_(2)—T_(5)时四组SBP、DBP明显降低(P<0.05),T_(2)时A3组RR明显增快(P<0.05),T_(5)时A3组RR明显减慢(P<0.05)。与A3组比较,A5组、A7组和A9组首次诱导成功率、患者满意率、检查医师满意率明显升高,麻醉诱导时间明显缩短,丙泊酚追加率、注射痛及体动反应发生率明显降低(P<0.05);A5组和A7组达离院标准时间明显缩短,麻醉科医师满意率明显升高(P<0.05);A9组苏醒时间明显延长,呼吸抑制发生率明显升高(P<0.05)。与A5组比较,A7组和A9组丙泊酚追加率明显降低(P<0.05);A9组苏醒时间、达离院标准时间明显延长,麻醉科医师满意率明显降低,呼吸抑制发生率明显升高(P<0.05)。与A7组比较,A9组苏醒时间、达离院标准时间明显延长,麻醉科医师满意率明显降低,呼吸抑制发生率明显升高(P<0.05)。结论阿芬太尼复合丙泊酚用于无痛胃镜检查安全有效,阿芬太尼7μg/kg复合丙泊酚用于无痛胃镜检查镇静镇痛效果佳,丙泊酚用量少,不良反应较少。

Objective To observe the efficacy and safety of alfentanil combined with propofol in painless gastroscopy,and to explore the optimal dose of alfentanil when combined with propofol in painless gastroscopy.Methods A total of 200 patients,87 males and 113 females,aged 18-60 years,BMI 18-28 kg/m^(2),ASA physical statusⅠorⅡ,who underwent painless gastroscopy from November 2020 to January 2021 were randomly divided into 4 groups:alfentanil 3μg/kg group(group A3),alfentanil 5μg/kg group(group A5),alfentanil 7μg/kg group(group A7)and alfentanil 9μg/kg group(group A9),50 patients in each group.The four groups were given alfentanil 3,5,7,9μg/kg intravenously 3 minutes after oxygen inhalation,respectively,and propofol 2 mg/kg intravenously 1 minute after injection.Modified observer s assessment of alertness and sedation(MOAA/S)scale was performed immediately after administration,and evaluated every 30 seconds until the MOAA/S≤3 scores.If the endoscopy failed or the MOAA/S score≥4 scores 2 minutes after injection,propofol was added for 0.5 mg/kg until MOAA/S≤3 scores,and the interval between each additional drug was more than 1 minute.The success cases of induction of first administration,induction time of anesthesia,operation time,recovery time and standard time of dicharge were recorded.SBP,DBP,HR,SpO_(2) and RR were recorded 1 minute before injection(T_(1)),at the time of MOAA/S≤3 scores(T_(2)),at the beginning of operation(T_(3)),1 minute after the beginning(T_(4))and at the end of operation(T_(5)).The additional cases of propofol,patient satisfaction,surgeon satisfaction and anesthesiologist satisfaction,the occurrence of injection pain and intraoperative adverse events(body reaction,respiratory depression and hypotension)were recorded.Results Compared with T_(1),SBP and DBP in the four groups were significantly decreased at T_(2)-T_(5)(P<0.05),RR in group A3 increased significantly at T_(2) and decreased significantly at T_(5)(P<0.05).Compared with group A3,the induction time of anesthesia in groups A5,A7,and A9 was significantly shorter,the success rate of first induction,the satisfaction rate of patients and surgeons were significantly higher,the additional cases of propofol,the incidence of body reaction and injection pain were significantly decreased(P<0.05).Compared with group A3,the standard hospital stay in groups A5 and A7 was significantly shortened,and the satisfaction rate of anesthesiologists was significantly increased(P<0.05).Compared with group A3,the recovery time and the incidence of respiratory depression in group A9 was significantly increased(P<0.05).Compared with group A5,the additional cases of propofol was significantly decreased in groups A7 and A9(P<0.05);the recovery time,the standard time to discharge and the incidence of respiratory depression were significantly increased,and the satisfaction rate of anesthesiologists was significantly decreased in group A9(P<0.05).Compared with group A7,the recovery time,the standard hospital stay and the incidence of respiratory depression in group A9 were significantly increased,and the satisfaction rate of anesthesiologists was significantly decreased(P<0.05).Conclusion Alfentanil combined with propofol for painless gastroscopy is safe,effective and feasible.Afentanil 7μg/kg combined with propofol has good sedative and analgesic effect with less propofol dosage and adverse reactions.