不同剂量阿芬太尼复合丙泊酚用于无痛胃镜检查中的效果观察

Clinical effect of different dosages alfentanil combined with propofol in painless gastroscopy

目的探讨不同剂量阿芬太尼复合丙泊酚用于无痛胃镜检查中的最佳剂量。方法选择行无痛胃镜检查的患者120例,随机分为4组:静注阿芬太尼2.5μg/kg组(O_(1)组,n=30)、5.0μg/kg组(O_(2)组,n=30)、7.5μg/kg组(O_(3)组,n=30)和10.0μg/kg组(O_(4)组,n=30),2 min后缓慢注射丙泊酚1.5 mg/kg,改良警觉/镇静(MOAA/S)评分≤3分时开始行胃镜检查。记录胃镜检查时间、胃镜检查过程中患者发生体动次数、丙泊酚用量、丙泊酚追加次数和患者苏醒时间;记录诱导前(T_(0))、诱导后MOAA/S评分≤3分满足胃镜检查要求时(T_(1))、胃镜通过咽喉部时(T_(2))和检查结束胃镜撤出时(T_(3))的平均动脉压(MAP)、心率(HR)和经皮动脉血氧饱和度(SpO_(2));记录并发症发生情况。结果与O_(1)组和O_(2)组相比,O_(4)组体动次数和丙泊酚用量明显减少,苏醒时间明显缩短;与O_(1)组相比,O_(3)组体动次数明显减少。与O_(1)组相比,O_(2)组、O_(3)组和O_(4)组需要追加丙泊酚的患者数明显减少,与O_(2)组和O_(3)组相比,O_(4)组需要追加丙泊酚的患者数明显减少。与T_(0)时点相比,T_(1)~T_(3)时点4组患者MAP明显降低;与T_(1)时点相比,T_(3)时点O_(3)组和O_(4)组MAP明显升高;与T_(0)时点相比,T_(1)~T_(3)时点O_(2)组、O_(3)组和O_(4)组HR明显降低;与T_(1)时点相比,O_(3)组T_(2)和T_(3)时点HR明显升高,O_(4)组T_(3)时点HR明显升高;与T_(0)和T_(1)时点相比,T_(2)和T_(3)时点O_(1)组、O_(2)组和O_(3)组SpO_(2)明显降低;T_(1)和T_(2)时点,O_(3)组和O_(4)组MAP较O_(1)组明显降低;T_(1)时点,O_(3)组和O_(4)组HR较O_(1)组明显降低,O_(4)组HR较O_(2)组明显降低;T_(2)时点,O_(4)组HR较O_(1)组明显降低;T_(3)时点,O_(4)组SpO_(2)较O_(1)组明显升高(P<0.05)。结论10.0μg/kg的阿芬太尼复合丙泊酚用于无痛胃镜检查,可以减少体动次数和丙泊酚用量,缩短苏醒时间,但其对血流动力学产生了抑制效应。

Objective To observe the effect of different dosages alfentanil combined with propofol in painless gastroscopy.Methods 120 patients underwent painless gastroscopy were selected.Patients were randomly assigned into four groups.Group O_(1) received alfentanil 2.5μg/kg intravenously(n=30),group O_(2) received alfentanil 5.0μg/kg(n=30),group O_(3) received alfentanil 7.5μg/kg(n=30),group O_(4) received alfentanil 10.0μg/kg(n=30).Patients in the four groups were given 1.5 mg/kg of propofol intravenously 2 min later,and painless gastroscopy was performed when the modified observer’s assessment of alert/sedation(MOAA/S)scale≤3.The gastroscopy time,the condition of body movement during gastroscopy,the total dosage of propofol,the times of additional propofol and the awake time of patients were recorded.Mean arterial pressure(MAP),heart rate(HR)and percutaneous arterial oxygen saturation(SpO_(2))were recorded before injection of test drug(T_(0)),when MOAA/S scale≤3 to meet the requirements of gastroscopy after drug administration(T_(1)),gastroscopy passed through the throat(T_(2))and gastroscope was removed after examination(T_(3)).And the complications rate were recorded.Result Compared with group O_(1) and group O_(2),the incidence of body movement and total dosage of propofol in group O_(4) were significantly reduced,the awake time was significantly shortened,the incidence of body movement in group O_(3) was significantly reduced;Compared with group O_(1),the number of patients in group O_(2)、O_(3)、O_(4) who need additional propofol was significantly reduced,and the number of patients in group O_(4) who need additional propofol was significantly reduced compared with group O_(2) and O_(3).Compared with T_(0),the MAP was significantly decreased at T_(1)~T_(3) in four groups;Compared with T_(1),the MAP of group O_(3) and group O_(4) were increased significantly at T_(3).Compared with T_(0),the HR of group O_(2),group O_(3) and group O_(4) were significantly decreased at T_(1)~T_(3);Compared with T_(1),the HR were significantly increased at T_(2)~T_(3) in group O_(3) and at T_(3) in group O_(4).Compared with T_(0) and T_(1),SpO_(2) in group O_(1),group O_(2) and group O_(3) were decreased significantly at T_(2)~T_(3).At T_(1) and T_(2),the MAP of group O_(3) and group O_(4) were significantly decreased than that of group O_(1).At T_(1),the HR of group O_(3) and group O_(4) were significantly decreased than that of group O_(1),and the HR of group O_(4) was significantly decreased than that of group O_(2);At T_(2),the HR of group O_(4) was significantly decreased than that of group O_(1).At T_(3),the SpO_(2) of group O_(4) was significantly increased than that of group O_(1)(P<0.05).Conclusion The 10.0μg/kg alfentanil combined with propofol used for painless gastroscopy can reduce the incidence of body movement during gastroscopy and total dosage of propofol,shorten the awaking time,but it has inhibitory effect on hemodynamics.