不同剂量布托啡诺在无痛胃肠镜检查中的应用研究

Application study of different doses of butorphanol in painless gastrointestinal endoscopy examination

目的观察不同剂量布托啡诺在无痛胃肠镜检查中的应用效果。方法选取接受无痛胃肠镜检查的患者240例,ASA分级Ⅰ~Ⅲ级,采用计算机随机数字表法分为PN组(丙泊酚+生理盐水)、PB1组(丙泊酚+布托啡诺10μg/kg)、PB2组(丙泊酚+布托啡诺20μg/kg)、PB3组(丙泊酚+布托啡诺30μg/kg),每组各60例。监测并记录患者的动脉氧饱和度、平均动脉压、心率、呼吸频率,比较各组丙泊酚用量、术后疼痛评分、舒适度评分、镇静评分,术中、术后30min内心动过缓、呼吸抑制、低血压、嗜睡、恶心呕吐、头晕的发生率。结果PN组患者丙泊酚用量显著多于PB1、PB2、PB33组(P<0.05)。PB1、PB2、PB33组间无统计学意义(P>0.05)。4组体动分级比例情况两两比较,PN、PB1组与PB2、PB3组之间差异有统计学意义(P<0.05),PN、PB1组I级比例明显低于PB2、PB3组,Ⅱ、Ⅲ级比例明显高于PB2、PB3组。PN、PB1组在心动过缓方面发生率明显高于PB2、PB3组(P<0.05),PN、PB1组低血压发生率明显高于PB2、PB3组(P<0.05),PB1、PB2、PB33组呼吸抑制差异无统计学意义。PB3组的恶心、呕吐、头晕明显高于PN、PB1、PB2组(P<0.05)。4组患者疼痛评分、舒适度评分差异无统计学意义(P>0.05)。Ramsay评分PB3组明显高于其他3组(P<0.05)。结论布托啡诺20μg/kg可显著减少无痛胃肠镜检查时的丙泊酚用量,不良反应发生率较低,是无痛胃肠镜检查较适宜的剂量。

Objective To observe the effects of different doses of butorphanol in painless gastrointestinal endoscopy examination.Methods 240 patients undergoing elective painless gastroscope with ASA grade I-III were selected and divided into PN group(propofol+normal saline),PB1 group(propofol+butorphanol 10μg/kg),PB2 group(propofol+butorphanol 20μg/kg)and PB3 group(propofol+butorphanol 30μg/kg)by computer random number table method,with 60 cases in each group.The arterial oxygen saturation,mean arterial pressure,heart rate and respiratory rate were monitored and recorded in each group.The dosages of propofol,postoperative pain scores,comfort scores,sedation scores,and incidences of bradycardia,respiratory depression,hypotension,drowsiness,nausea and vomiting,and dizziness during procedure and within 30 minutes after procedure were compared among groups.Results The dosage of propofol in PN group was significantly higher than those in PB1,PB2 and PB3 groups(P<0.05),while there was no difference among PB1,PB2 and PB3 groups(P>0.05).Pairwise comparison of the proportions showed there were significant differences in body movement during procedure between PN and PB1 groups and PB2 and PB3 groups,with the proportion of grade I in groups PN and PB1 significantly lower than that in groups PB2 and PB3,and the proportion of grade II and III in groups PN and PB1 significantly higher than that in groups PB2 and PB3.The incidences of bradycardia in PN and PB1 groups were significantly higher than those in PB2 and PB3 groups(P<0.05),and the incidences of hypotension in PN and PB1 groups were also significantly higher than those in PB2 and PB3 groups(P<0.05),while there were no significant differences in the incidences of respiratory depression among PB1,PB2 and PB3 groups.The incidences of nausea,vomiting and dizziness in PB3 group were significantly higher than those in PN,PB1 and PB2 groups(P<0.05).There were no significant differences in the pain scores and comfort scores among four groups(P>0.05).The Ramsay score in PB3 group was significantly higher than those in the other groups(P<0.05).Conclusion Butorphanol 20μg/kg can effectively reduce dose of propofol during gastrointestinal endoscopy examination,with lower incidence of adverse reactions,which is an appropriate dose for gastrointestinal endoscopy examination.