不同剂量阿芬太尼复合丙泊酚中长链脂肪乳用于无痛胃镜诊疗的效果评价

Effect Evaluation of Different Doses of Alfentanil Combined with Propofol Medium/Long-Chain Triglyceride Emulsion for Patient in the Diagnosis and Treatment of Gastroscopy

目的 评价不同剂量阿芬太尼复合丙泊酚中长链脂肪乳用于无痛胃镜诊疗的效果。方法 选择ASA I或Ⅱ级拟在静脉全身麻醉下行胃镜诊疗患者700例,年龄18~64岁,体质量45~75 kg,性别不限,随机分为七组(n=100):丙泊酚中长链脂肪乳组(P组)、阿芬太尼组(各组均用生理盐水稀释至0.1 ml/kg)5μg/kg(F5组)、6μg/kg(F6组)、7μg/kg(F7组)、8μg/kg(F8组)、9μg/kg(F9组)、10μg/kg(F10组)。采用双盲法给药。F5~F10组分别静脉注射阿芬太尼5、6、7、8、9、10μg/kg, P组静脉注射等量生理盐水,1 min后各组再缓慢推注丙泊酚中长链脂肪乳直至改良清醒镇静(MOAA/S)评分为0分为止。记录诊疗时间、清醒时间、复苏时间、丙泊酚中长链脂肪乳用量、麻黄碱与阿托品使用情况、患者清醒后10 min VAS评分、麻醉者和术者满意度及不良反应情况。结果 与P组比较,F5~F10各组丙泊酚中长链脂肪乳用量减少,清醒时间、复苏时间缩短,清醒后10 min VAS评分、体动、呼吸暂停、低氧血症和低血压发生率降低,麻黄碱使用例数减少,麻醉者及术者满意度提高(P<0.05);与F5组比较,F7、F8、F9和F10组丙泊酚中长链脂肪乳用量减少,体动、清醒后10 min VAS评分降低,F7、F8和F9组清醒时间和复苏时间缩短,呼吸暂停、低氧血症、低血压发生率及麻黄碱使用例数减少(P<0.05);与F8组比较,F6和F7组丙泊酚中长链脂肪乳用量和体动发生率增加,F6和F10组清醒时间和复苏时间延长,F6、F7、F9和F10组呼吸暂停、低氧血症、低血压发生率及麻黄碱使用例数增加,麻醉者满意度降低(P<0.05)。结论 阿芬太尼5、6、7、8、9、10μg/kg复合丙泊酚中长链脂肪乳用于无痛胃镜诊疗,其阿芬太尼剂量8μg/kg更安全有效、恢复更快。

Objective To evaluate the anesthetic effect of different doses of alfentanil combined with propofol medium/long-chain triglyceride emulsion for patien in the diagnosis and treatment gastroscopic. Methods 700 ASA I or Ⅱ patiens aged 18~64 years weighting 45~75 of both sexes undergoing gastroscopy diagnosis and treatment were randomly divided into 7 groups(n=100 each):group P(propofol medium/long-chain triglyceride emulsion),alfentanil group(all groups were diluted to 0. 1mL/kg with saline):5 μg/kg(F5 group),6 μg/kg(F6 group),7 μg/kg(F7 group),8 μg/kg(F8 group),9 μg/kg(F9 group),and 10 μg/kg(F10 group). Patients received one of the seven anesthetic combinations in a double-blind fashion. Groups F5 to F10 were injected with 5,6,7,8,9,and 10 μg/kg of alfentanil respectively,Group P was injected with the same volume of saline. After 1 min,each group was slowly injected with propofol medium/long chain triglyceride emulsion until modified observer`s assessment of alertness/sedation(MOAA/S)score reached to 0 points. Diagnosis and treatment time,awake time,resuscitation time,amount of propofol medium/long-chain triglyceride emulsion,use of ephedrine and atropine,VAS score after the patient woke up for 10 minutes,satisfaction of anesthesiologists and operators and adverse reactions were all detected.Results Compared with P group,with the dosage of propofol medium/long-chain triglyceride emulsion in each group from F5 to F10 decreased,wake-up time and resuscitation time were shortened,and VAS score,body movement,apnea,hypoxemia and hypotension incidences decreased,and the number of ephedrine use cases decreased. Moreover,satisfaction of anesthesiologists and operators increased(P<0. 05). Compared with F5 group,doseage of propofol medium/long-chain triglyceride emulsion decreased in F7,F8,F9 and F10 groups,and body movement and VAS score were also decreased. Meanwhile,waken up and resuscitation time were shorten in F7,F8,F9 groups. The incidence of apnea,hypoxemia,hypotension and ephedrine use were also decreased(P<0. 05). Compared with F8 group,the amount ofpropofol medium/long-chain triglyceride emulsion and the incidence of physical activity in the F6 and F7 groups were increased,the wake-up time and the recovery time in the F6 and F10 groups were prolonged,and the apnea,hypoxemia,hypotension abd the use case of ephedrine in the F6,F7,F9 and F10 groupswere all increased,while the satisfaction of anesthetists decreased(P<0. 05).Conclusion Alfentanil 8 μg/kg compound propofol medium/long-chain triglyceride emulsion was safe or effective and faster recovery for painless gastroscopy treatment.