阿芬太尼复合丙泊酚在胃镜联合肠镜检查中的应用

The application of alfentanil combined with propofol in gastroscopy and colonoscopy

目的 比较阿芬太尼与芬太尼复合丙泊酚用于胃镜联合肠镜检查的临床效果和不良反应发生情况。方法 纳入2022年4—6月延安市中医医院行无痛胃镜联合肠镜检查的患者,采用随机数字表法分为2组。观察组选择阿芬太尼5μg/kg联合丙泊酚1~2 mg/kg、对照组选择芬太尼1μg/kg联合丙泊酚1~2 mg/kg行麻醉诱导,所有患者术中丙泊酚每小时4~6 mg/kg持续泵注。记录麻醉前(T_(1))、胃镜检查开始(T_(2))、胃镜至十二指肠降部(T_(3))、肠镜开始(T_(4))、肠镜至回盲瓣(T_(5))时的平均动脉压(MAP)和Ramsay镇静评分(RSS)。记录操作时长、丙泊酚追加例数、丙泊酚追加次数、丙泊酚总用量、苏醒时间和不良反应(低氧血症、丙泊酚注射痛、低血压、呛咳、头晕、体动、恶心呕吐及嗜睡)发生率。结果 共纳入110例患者,观察组和对照组各55例,T_(3)时观察组RSS显著低于对照组(P<0.05),其余时点两组RSS比较差异无统计学意义(P>0.05)。与T_(1)相比,T_(2)~T_(5)时两组患者MAP显著降低(P<0.05),T_(1)和T_(2)时两组MAP比较差异无统计学意义(P>0.05),T_(3)~T_(5)时观察组MAP显著高于对照组(P<0.05)。观察组低氧血症发生率显著低于对照组(P<0.05),丙泊酚追加例数、丙泊酚累计用量显著高于对照组(P<0.05),苏醒时间显著长于对照组(P<0.05)。结论 与芬太尼相比,阿芬太尼联合丙泊酚用于胃镜联合肠镜检查低氧血症发生率更低,血压更平稳,安全性更高。

Objective To compare the effectiveness and safety of combinations use of propofol-alfentanil and propofolfentanyl for sedation-analgesia in elective colonoscopy patients.Methods The patients who underwent painless gastrointestinal endoscopy in Yan'an City Hospital of TCM from April 2022 to June 2022 were included in the study and divided into 2 groups by the random number table method.The control group was given anesthesia with propofol (1~2 mg/kg) combined with alfentanil(5μg/kg),and the observation group was given anesthesia with propofol (1~2 mg/kg) combined with fentanil (1μg/kg),each patients was administered 4~6 mg/kg every hour propofol for induction.MAP and RSS were recorded from T_(1) to T_(5).The operation time,the number of cases with additional dose of propofol,the number of doses of additional propofol,total dosage of propofol,recovery time and complications (hypoxaemia,injection pain,hypotension,cough,dizziness,body reaction,nausea and vomiting,drowsiness) were recorded.Results A total of 110 patients were included,with 55 cases in observation group and 50 cases in the control group.The RSS value of the control group was significantly lower at T_(3) than that in the observation group (P<0.05).There were no statistically significant differences at T_(1),T_(2),T_(4) and T_(5) between the two groups(P>0.05).Compared with T_(1),MAP in the two groups were significantly decreased at T_(2)~T_(5) (P>0.05).There were no statistically significant differences about MAP at T_(1) and T_(2) (P<0.05).The MAP of the control group was significantly higher at T_(3)~T_(5) than that of observation group (P<0.05).Compared with the observation group,the incidence of hypoxaemia in control group was significantly decreased (P<0.05),the number of cases with additional dose of propofol and the total dosage of propofol in control group was significantly higher (P<0.05),the recovery time in the control group was significantly longer (P<0.05).Conclusion Compared with fentanyl,the combination use of alfentanil and propofol has lower incidence of hypoxemia,more stable blood pressure and better safety in gastroscopy and colonoscopy.