不同剂量阿芬太尼复合丙泊酚在胃镜检查中的应用

Application of different doses of alfentanil combined with propofol in gastroscopy

目的探讨不同剂量阿芬太尼复合丙泊酚在胃镜检查中的应用效果。方法选择门诊无痛胃镜检查患者60例,男28例,女32例,年龄18~64岁,BMI 18~25 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为三组:丙泊酚组(P组)、阿芬太尼7μg/kg复合丙泊酚组(A1组)和阿芬太尼10μg/kg复合丙泊酚组(A2组),每组20例。A1组静脉注射阿芬太尼7μg/kg,A2组静脉注射阿芬太尼10μg/kg,P组静脉注射等容量生理盐水20 ml。静脉泵注丙泊酚2.0 mg·kg^(-1)·min^(-1)至改良警觉/镇静评分(MOAA/S)为0分时开始胃镜操作。记录入室时(T_(0))、给药后MOAA/S评分为0分时(T_(1))、胃镜通过咽喉部(T_(2))、胃镜抵达十二指肠降部(T_(3))、胃镜检查结束时(T_(4))、胃镜检查结束后MOAA/S评分为5分时(T_(5))、离院时(T_(6))的MAP、HR、SpO_(2)。记录丙泊酚诱导量、追加情况、总用量、胃镜操作时间、清醒时间和离院时间。记录麻醉期间亚临床呼吸抑制例数。记录T_(0)、T_(5)、T_(6)和离院后24 h(T_(7))的Christensen疲劳评分。记录胃镜操作过程中体动、低血压、高血压、心动过缓、反流误吸等并发症的发生情况。结果与T_(0)时比较,T_(1)—T_(4)时三组MAP明显降低、HR明显减慢(P<0.05),T_(5)、T_(6)时三组Christensen疲劳评分降低(P<0.05)。与P组比较,T_(1)、T_(2)时A1组MAP明显升高(P<0.05),T_(1)—T_(4)时A2组MAP明显升高(P<0.05);A1组和A2组丙泊酚诱导量和总用量明显减少、追加率明显降低(P<0.05),清醒时间和离院时间明显缩短(P<0.05),亚临床呼吸抑制发生率明显降低(P<0.05),T_(5)、T_(6)时A1组和A2组Christensen疲劳评分明显降低(P<0.05),A1组和A2组体动发生率明显降低(P<0.05),A2组低血压发生率明显降低(P<0.05)。与A1组比较,T_(3)、T_(4)时A2组MAP明显升高(P<0.05),A2组丙泊酚追明显降低、总用量明显减少,清醒时间、离院时间明显缩短(P<0.05),T_(6)时A2组Christensen疲劳评分明显降低(P<0.05)。结论与单纯应用丙泊酚镇静比较,阿芬太尼复合丙泊酚应用于无痛胃镜检查,可降低亚临床呼吸抑制发生率,缩短清醒时间和离院时间,提高恢复质量,阿芬太尼10μg/kg较7μg/kg复合丙泊酚效果更优。

Objective To investigate the application of different doses of alfentanil combined with propofol in patients undergoing gastroscopy.Methods Sixty patients scheduled to undergo gastroscopy,28 males and 32 females,aged 18-64 years,BMI 18-25 kg/m^(2),ASA physical statusⅠorⅡ,were randomly divided into three groups:propofol group(group P),alfentanil 7μg/kg+propofol group(group A1)and alfentanil 10μg/kg+propofol group(group A2),20 patients in each group.Patients received alfentanil 7μg/kg in group A1,alfentanil 10μg/kg in group A2,and normal saline in group P.Then all patients received propofol 2.0 mg·kg^(-1)·min^(-1),titrated to an alertness/sedation(MOAA/S)score being of 0.Then gastroscopy began.MAP,HR and SpO_(2) were recorded when the patient entered the room(T_(0)),MOAA/S score being 0 after drug administration(T_(1)),gastroscope passed through the pharynx and larynx(T_(2)),the gastroscope arrived at the descending part of the duodenum(T_(3)),at the end of gastroscopy(T_(4)),MOAA/S score being 5 after gastroscopy(T_(5)),and discharge(T_(6)).Propofol-induced dose,condition of adding,and the total dosage of propofol,gastroscopy time,awake time,and discharge time were recorded.The incidence of subclinical respiratory depression were recorded.The Christensen fatigue scores of patients at T_(0),T_(5),T_(6) and 24 hours after discharge(T 7)were recorded.The occurrence of complications such as body movement,hypotension,hypertension,bradycardia,and reflux aspiration during gastroscopy were recorded.Results Compared with T_(0),MAP and HR were significantly decreased at T_(1)-T_(4) in the three groups(P<0.05),the Christensen fatigue scores were lower at T_(5) and T_(6) in the three groups(P<0.05).Compared with group P,MAP was significantly increased at T_(1) and T_(2) in group A1,and at T_(1)-T_(4) in group A2(P<0.05),propofol-induced dose,the total dosage,and the addition rate of propofol were reduced,and awake time and discharge time shortened significantly in groups A1 and A2(P<0.05),the incidence of subclinical respiratory depression was significantly lower in groups A1 and A2(P<0.05),the Christensen fatigue scores were significantly lower at T_(5) and T_(6) in groups A1 and A2(P<0.05),the incidence of physical activity in groups A1 and A2 was significantly lower,and the incidence of hypotension in group A2 was significantly lower(P<0.05).Compared with group A1,MAP was significantly increased at T_(3) and T_(4) in group A2(P<0.05),the Christensen fatigue scores in group A2 was signficantly lower at T_(6)(P<0.05),the addition rate and total dosage of propofol were reduced,and awake time and discharge time were significantly shortened in group A2(P<0.05).Conclusion Compared to propofol alone,alfentanil combined with propofol can reduce the incidence of subclinical respiratory depression in patients undergoing gastroscopy,shorten the time of awake and discharge,and improve the quality of recovery.Compared with alfentanil 7μg/kg,alfentanil 10μg/kg has more advantages.