Dixon序贯法测定丙泊酚镇静抑制老年患者胃镜插入反应的半数有效剂量

Half effective dose of propofol sedation inhibiting response to inserted gastroscope with Dixon sequential method in eldly patients

目的应用Dixon序贯法来研究丙泊酚镇静抑制老年患者对胃镜插入反应的半数有效剂量。方法采用前瞻性研究方法,选取2021年3~6月于首都医科大学附属北京友谊医院消化内镜中心拟行无痛胃镜检查的75~84岁老年患者31例,美国麻醉医师协会分级Ⅰ~Ⅱ级,均监测心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2))。丙泊酚剂量由1.1 mg/kg(第1例患者)开始,阶梯剂量为0.1 mg/kg,后续患者的丙泊酚剂量由前1例患者的胃镜插入反应确定,插入反应未抑制则增加0.1 mg/kg,插入反应抑制则减少药物,将"胃镜插入反应阳性—插入反应阴性"这一变化视为拐点,出现7个拐点时即停止纳入。记录患者镇静前、胃镜进镜、进镜后2 min、检查结束时的心率、MAP、SpO_(2)变化,记录恶心呕吐、咳嗽呛咳、吞咽、体动等胃镜插入反应。计量资料以均数±标准差(±s)表示,不同时间点的变化比较采用重复测量资料方差分析。结果丙泊酚镇静抑制老年患者胃镜插入反应的半数有效剂量为(1.11±0.16)mg/kg,MAP在镇静前、胃镜进镜、进镜后2 min、检查结束时分别为(105.05±13.39)、(90.48±10.98)、(90.48±11.11)、(82.68±9.98)mmHg,给药后各观察点MAP较麻醉前明显降低,差异均具有统计学意义(P<0.05)。心率在镇静前、胃镜进镜、进镜后2 min、检查结束时分别为(77.26±12.67)、(72.81±10.39)、(72.90±11.63)、(68.32±9.42)次/min,给药后各观察点心率较镇静前明显降低,差异均具有统计学意义(P<0.05)。SpO_(2)在镇静前、胃镜进镜、进镜后2 min、检查结束时分别为(96.48±1.81)%、(98.65±1.31)%、(97.36±2.14)%、(96.48±1.81)%,镇静前SpO_(2)与胃镜进镜时相比,差异明显具有统计学意义(P<0.001),胃镜进镜时SpO_(2)与进镜后2 min、检查结束时相比,差异均具有统计学意义(P<0.05)。结论通过Dixon序贯法确定丙泊酚镇静抑制胃镜插入反应的半数有效剂量为(1.11±0.16)mg/kg。

Objective To study the half effective dose of propofol inhibiting pharyngeal response of elderly patients to inserted gastroscope under anesthesia by Dixon sequential method.Methods In this prospective study,31 elderly patients aged 75 to 84 years who planned to undergo painless gastroscopy at the Digestive Endoscopy Center of Beijing Friendship Hospital,Capital Medical University from March to June 2021 were enrolled,American Society of Anesthesiologists classⅠ-Ⅱ.The heart rate(HR),mean arterial pressure(MAP),peripheral pulse oxygen saturation(SpO_(2))were monitored.The propofol dose started at 1.1 mg/kg(the first patient),and the gap dose was 0.1 mg/kg.The sequential dose given to the patient increased by 0.1 mg/kg if the pharyngeal response to inserted gastroscope of the previous patient was not considered inhibited or decreased by 0.1 mg/kg if the pharyngeal response was inhibited,the positive pharyngeal response-inhibited pharyngeal response was regarded as one crossover,and this study stopped after the seventh crossover.The change of MAP,HR and SpO_(2)prior to anesthesia,insertion of gastroscope,2 minutes after insertion,after gastroscopy was recorded.Nausea and vomiting,cough and swallowing,and body movement were also recorded.The measurement data were expressed as mean±standard deviation(±s),and the changes at different time points were compared by repeated measurement data ANOVA.Results The half effective dose of propofol inhibiting pharyngeal response to inserted gastroscope was(1.11±0.16)mg/kg.The MAP prior to anesthesia,insertion of gastroscope,2 minutes after insertion,after gastroscopy were(105.05±13.39)mmHg,(90.48±10.98)mmHg,(90.48±11.11)mmHg,(82.68±9.98)mmHg,respectively,and the MAP at each observation point after administration was significantly lower than that before anesthesia,the differences were statistically significant(P<0.05).The HR prior to anesthesia,insertion of gastroscope,2 minutes after insertion,after gastroscopy were 77.26±12.67,72.81±10.39,72.90±11.63,68.32±9.42,respectively,and the HR at each observation point after administration was significantly lower than that before sedation,the differences were statistically significant(P<0.05).The SpO_(2)prior to anesthesia,insertion of gastroscope,2 minutes after insertion,after gastroscopy were(96.48±1.81)%,(98.65±1.31)%,(97.36±2.14)%,(96.48±1.81)%,respectively,and the SpO_(2)prior to anesthesia was statistically significant compared with insertion of gastroscope(P<0.001),the SpO_(2)of 2 minutes after insertion,and after gastroscopy were significant differences compared with insertion of gastroscope(P<0.05).Conclusion Half effective dose of propofol for inhibiting pharyngeal response to inserted gastroscope under anesthesia by Dixon sequential method was determined as(1.11±0.16)mg/kg.