舒芬太尼、瑞芬太尼和芬太尼辅助丙泊酚在无痛胃肠镜检查中的应用

Application of sufentanil,remifentanil and fentanyl combined with propofol in painless gastrointestinal endoscopy

目的观察舒芬太尼、瑞芬太尼、芬太尼辅助丙泊酚在门诊无痛胃肠镜检查中的应用。方法选取门诊行无痛胃肠镜检查的患者240例,随机分为3组:F组(芬太尼组)、S组(舒芬太尼组)和R组(瑞芬太尼组),每组80例。F组静脉注射芬太尼,S组静脉注射舒芬太尼,R组静脉注射瑞芬太尼,3组均静脉注射丙泊酚。比较3组的一般资料、麻醉情况、镜检操作时间和丙泊酚总用量;记录3组镜检前、镜检时和镜检后5 min的生命体征;观察并记录3组麻醉时心律失常、舌后坠、呼吸暂停和麻醉后恶心呕吐、腹部不适和嗜睡不良情况的发生率。结果3组一般资料、镇痛镇静效果比较,差异无统计学意义(P>0.05);S组、R组起效时间和苏醒时间较F组短,R组起效时间、苏醒时间和清醒时间较S组短(P<0.05),F组和S组清醒时间比较差异无统计学意义(P>0.05);3组操作时间的差异无统计学意义(P>0.05);S组、R组丙泊酚的总用量少于F组(P<0.05),R组丙泊酚的总用量少于S组(P<0.05);镜检时3组的心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)和氧饱和度(oxygen saturation,SpO_(2))均低于镜检前(P<0.05),镜检后5 min的HR、MAP和SpO_(2)均高于镜检时(P<0.05),镜检前与镜检后5 min比较差异无统计学意义(P>0.05);R组镜检时的MAP、SpO_(2)均低于F组、S组(P<0.05),F组、S组各时间点HR、MAP和SpO_(2)比较差异均无统计学意义;3组麻醉时及麻醉后不良反应比较差异无统计学意义(P>0.05)。结论3组用药在无痛胃肠镜检查中安全性高,瑞芬太尼在起效时间、苏醒时间和清醒时间以及丙泊酚总用量上低于舒芬太尼、芬太尼,但瑞芬太尼对呼吸的抑制最明显。

Objective To observe the application of sufentanil,remifentanil and fentanyl combined with propofol in outpatient painless gastrointestinal endoscopy.Methods A total of 240 patients who underwent painless gastrointestinal endoscopy in the outpatient department of the hospital were enrolled,and randomly divided into group F(fentanyl group),group S(sufentanil group),and group R(remifentanil group),with 80 cases in each group.All patients were injected with propofol.In addition,patients in group F,group S and group R were given intravenous injection of fentanyl,sufentanil and remifentanil,respectively.The general data,anesthesia conditions,duration of examination,and the total dosage of propofol were compared among the 3 groups.The vital signs of the 3 groups before examination,during examination,and after 5 minutes of examination were recorded.The incidence rates of adverse reactions in the 3 groups during and after anesthesia were recorded.Results The general data,analgesic and sedative effects of the 3 groups were similar(P>0.05).The onset time and awakening time of group S and group R were shorter than those of group F.The onset time,awakening time and waking time of group R were shorter than those of group F(P<0.05).There was no significant difference in waking time between group F and group S(P>0.05).The operation time of the 3 groups was similar.The total dosages of propofol in group S and group R were lower than that in group F(P<0.05),and the total dosage of propofol in group R was lower than that in group S(P<0.05).The heart rate(HR),mean arterial pressure(MAP)and oxygen saturation(SpO_(2))in the 3 groups during examination were lower than those before examination(P<0.05).The 3 indicators after 5 minutes of examination were higher than those during examination(P<0.05),but there was no significant difference before examination and after 5 minutes of examination(P>0.05).The MAP and SpO_(2) in group R during examination were lower than those in group F and group S.There was no statistically significant difference in HR,MAP or SpO_(2) between group F and group S(P>0.05).The incidence rates of adverse reactions during and after anesthesia showed no statistically significant difference among the 3 groups(P>0.05).Conclusion The 3 adminiatration regimes are safe in painless gastrointestinal endoscopy.The onset time,awakening time,waking time and total dosage of propofol of anesthesia with remifentanil combined with propofol are shorter/lower than those of sufentanil or fentanyl combined with propofol.Anesthesia with remifentanil combined with propofol results in the most obvious respiratory depression.