环泊酚与丙泊酚复合小剂量阿芬太尼在胃肠镜检查中的应用

Application of cypropofol and propofol combined with low-dose alfentanil in gastroenteroscopy

目的 研究环泊酚与丙泊酚分别复合小剂量阿芬太尼用于胃肠镜检查麻醉效果和不良反应。方法 选择2024年1-2月于兰州大学第一医院消化内镜中心择期行胃肠镜检查的患者162例,男86例,女76例,年龄18~65岁,BMI 18~30 kg/m^(2),ASA≤Ⅱ级。将患者随机分为2组,每组81例:丙泊酚组(P组)和环泊酚组(C组)。所有患者静注阿芬太尼7μg/kg,30 s后P组静注丙泊酚2 mg/kg、C组静注环泊酚0.4 mg/kg;待患者改良警觉/镇静评分(modified observer’s assessment of alertness/sedation,MOAA/S)≤1分,开始胃镜进镜操作。记录检查时间、镇静成功例数、诱导时间、苏醒时间。记录患者心率、血压、脉搏血氧饱度。记录低血压、呼吸抑制、注射痛、术中体动、恶心呕吐等不良反应发生情况,及内镜医师和患者对麻醉的满意度。结果 2组患者镇静成功率、诱导时间、苏醒时间差异均无统计学意义。与P组比较,C组患者术中生命体征更平稳,C组注射痛、呼吸抑制、低血压发生率均明显降低(P<0.05),患者对麻醉的满意度明显增高(P<0.05),2组内镜医师对麻醉的满意度差异无统计学意义。结论 复合小剂量阿芬太尼,环泊酚0.4 mg/kg在胃肠镜诊疗中能提供与丙泊酚2 mg/kg相似的镇静效果,诱导和苏醒时间相当;患者术中生命体征更平稳,低血压、呼吸抑制、注射痛等不良反应少,患者满意度高,值得临床推广。

Objective To investigate the anesthetic effects and adverse effects of cypropofol and propofol combined with alfentanil,respectively,for gastroenteroscopy.Methods A total of 162 patients who underwent elective gastroenteroscopy at the Gastrointestinal Endoscopy Center of the First Hospital of Lanzhou University from January to February 2024 were enrolled,including 86 males and 76 females,at an age of 18~65 years old,with a BMI value of 18~30 kg/m~2,and ASA grade ≤Ⅱ.They were randomly divided into propofol group(Group P) and cypropofol group(Group C),with 81 cases in each group.All patients were sedated with 0.7 μg/kg alfentanil,and in 30 s later,2 mg/kg propofol and 0.4 mg/kg cypropofol was intravenously dripped into Group P and Group C,respectively.When the modified alertness/sedation score(MOAA/S) ≤1,a gastroscope was started to insert.The related indicators,including total procedure time,successful cases of sedation,induction time and awakening time,heart rate,blood pressure,and pulse oximetry saturation were recorded,occurrence of adverse reactions such as hypotension,respiratory depression,injection pain,intraoperative body movement,nausea and vomiting were observed,and the satisfaction of endoscopists and of patients to anesthesia were recorded and compared between the 2 groups.Results There were no statistical differences in the success rate of sedation,induction time and awakening time between the 2 groups.The patients of the Group C had more stable intraoperative vital signs,statistically lower incidences of injection pain,respiratory depression and hypotension(P<0.05),and increased satisfaction for anesthesia(P<0.05) when compared with those in Group P.No obvious difference were observed in the satisfaction of endoscopist to anesthesia between the 2 groups.Conclusion In combination with small-dose alfentanil,0.4 mg/kg cypropofol shows similar sedation effect as 2 mg/kg propofol in gastroenteroscopy,with comparable induction and awakening time.Cypropofol has more advantages in stable intraoperative vital signs,less adverse effects such as low blood pressure,respiratory depression and injection pain,higher the patient satisfaction,which is worthy of clinical promotion.