不同剂量地佐辛对无痛胃镜麻醉丙泊酚ED50的影响

Effects of different doses of dezocine on propofol ED50 during painless gastroscopic anesthesia

目的测定丙泊酚复合不同剂量地佐辛行无痛胃镜麻醉时的半数有效量(ED_(50))。方法选取行无痛胃镜检查的患者,采用随机数字表法分为A组(丙泊酚+生理盐水2 ml)、D1组(丙泊酚+地佐辛30μg/kg)、D2组(丙泊酚+地佐辛60μg/kg)三组。丙泊酚采用序贯法按阶梯静脉注射给药,相邻剂量比1∶1.1。每组第1例患者丙泊酚诱导剂量自2.0 mg/kg始,样本例数以出现7个从阳性到阴性的反折点计算,至完成7次反应折点时A组入选22例患者,D1组入选25例患者,D2组入选24例患者。比较三组患者的基线资料;绘制三组患者的丙泊酚剂量序贯图,分析丙泊酚的ED_(50)和90%有效量(ED90)及其95%置信区间(95%CI)统计结果;比较三组胃镜检查时间、丙泊酚总用量、苏醒时间及术后不良反应发生情况。结果三组患者的年龄、体重、性别比较,差异无统计学意义(P>0.05)。A组丙泊酚的ED_(50)为2.317 mg/kg[95%CI=(2.193,2.479)mg/kg]、ED90为2.501 mg/kg[95%CI=(2.388,3.121)mg/kg];D1组丙泊酚的ED_(50)为1.877 mg/kg[95%CI=(1.751,1.989)mg/kg]、ED90为2.055 mg/kg[95%CI=(1.957,2.551)mg/kg];D2组丙泊酚的ED_(50)为1.754 mg/kg[95%CI=(1.548,1.908)mg/kg]、ED90为1.997 mg/kg[95%CI=(1.865,2.915)mg/kg]。三组胃镜检查时间两两比较,差异无统计学意义(P>0.05)。D1组和D2组的丙泊酚总用量分别为(16.16±2.79)、(15.58±2.69)ml,少于A组的(21.05±2.65)ml,差异具有统计学意义(P<0.05);D1组和D2组的丙泊酚总用量比较,差异无统计学意义(P>0.05)。D1组的术后苏醒时间(7.44±2.57)min短于A组的(9.86±2.93)min和D2组的(10.00±2.87)min,差异具有统计学意义(P<0.05);A组和D2组的术后苏醒时间比较,差异无统计学意义(P>0.05)。D2组患者术后不良反应发生率33.33%高于A组的9.09%和D1组的4.00%,差异具有统计学意义(P<0.05);A组和D1组患者术后不良反应发生率比较,差异无统计学意义(P>0.05)。结论地佐辛30μg/kg复合丙泊酚用于无痛胃镜检查时丙泊酚的ED_(50)和ED_(90)分别为1.877、2.055 mg/kg;地佐辛60μg/kg复合丙泊酚用于无痛胃镜检查时丙泊酚的ED_(50)和ED_(90)分别为1.754、1.997 mg/kg。其中地佐辛30μg/kg复合丙泊酚麻醉苏醒时间短,不良反应少,更加安全有效。

Objective To determine the median effective dose(ED_(50))of propofol combined with different doses of dexocine in painless gastroscopic anesthesia.Methods Patients undergoing painless gastroscopy were selected and divided into group A(propofol and normal saline 2 ml),group D1(propofol and dezocine 30μg/kg)and group D2(propofol and dezocine 60μg/kg)according the random numerical table.Propofol was administered intravenously by up-and-down sequential method with an adjacent dose ratio of 1∶1.1.The induction dose of propofol in the first patient in each group started at 2.0 mg/kg,and the number of sample cases was counted by the occurrence of 7 inflection points from positive to negative,and 22 patients were enrolled in group A,25 patients in group D1,and 24 patients in group D2 by the completion of 7 inflection points.Baseline data of the three groups were compared;sequential diagram of propofol dose were drawn for the three groups,and the statistical results of propofol ED_(50),90%effective dose(ED90)and 95%confidence interval(95%CI)were analyzed.The time to gastroscopy,total propofol consumption,recovery time,and occurrence of postoperative adverse reactions were compared among the three groups.Results There was no statistically significant difference in age,weight and gender among the three groups(P>0.05).The propofol ED_(50) and ED90 of group A were 2.317 mg/kg[95%CI=(2.193,2.479)mg/kg]and 2.501 mg/kg[95%CI=(2.388,3.121)mg/kg];the propofol ED_(50) and ED90 of group D1 were 1.877 mg/kg[95%CI=(1.751,1.989)mg/kg]and 2.055 mg/kg[95%CI=(1.957,2.551)mg/kg];the propofol ED_(50) and ED90 of group D2 were 1.754 mg/kg[95%CI=(1.548,1.908)mg/kg]and 1.997 mg/kg[95%CI=(1.865,2.915)mg/kg].There was no statistically significant difference in the time to gastroscopy among the three groups(P>0.05).The total dosage of propofol in group D1 and group D2 were(16.16±2.79)and(15.58±2.69)ml,which were less than that of(21.05±2.65)ml in group A,and the difference was statistically significant(P<0.05).There was no statistically significant difference in total propofol consumption between group D1 and group D2(P>0.05).The postoperative wake-up time of(7.44±2.57)min in group D1 was shorter than that of(9.86±2.93)min in group A and(10.00±2.87)min in group D2,and the differences were statistically significant(P<0.05).There was no statistically significant difference in postoperative wake-up time between group A and group D2(P>0.05).The incidence of postoperative adverse reactions in group D2 was 33.33%,which was higher than that of 9.09%in group A and 4.00%in group D1,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of postoperative adverse reactions between group A and group D1(P>0.05).Conclusion The propofol ED_(50) and ED_(90) of propofol are 1.877 and 2.055 mg/kg when dezocine 30μg/kg combined with propofol used in painless gastroscopy;the propofol ED_(50) and ED_(90) of propofol are 1.754 and 1.997 mg/kg when dezocine 60μg/kg combined with propofol used in painless gastroscopy.Among them,dezocine 30μg/kg combined with propofol for anesthesia is more safe and effective,with shorter wake-up time and fewer adverse reactions.