靶控输注丙泊酚-瑞芬太尼清醒镇静镇痛用于老年人结肠镜检查

目的研究靶控输注异丙酚-瑞芬太尼清醒镇静镇痛用于老年人结肠镜检查的有效性、安全性。方法70例美国麻醉医师协会(ASA)Ⅰ￣Ⅲ级行结肠镜检查的老年患者,随机分为麻醉组(T组)和对照组(C组),每组35例。T组:异丙酚血浆靶浓度0.4￣1.0μg/ml、瑞芬太尼血浆靶浓度0.4￣0.9ng/ml同时输注,待患者进入镇静分级评分(Ramsay)2级开始镜检,肠镜抵达回盲部停止给药。C组:未用药。结果Ramsay评分:T组2级86%,C组2级20%(P<0.01)。视觉模拟评分(VAS):T组明显小于C组(P<0.01)。T组入镜时间短于C组(P<0.05)。检查过程中:收缩压(SBP)、舒张压(DBP)、心率(HR)C组明显上升(P<0.05或0.01);脑电双频指数(BIS)T组明显降低(P<0.01);血糖C组升高(P<0.05)。T组检查成功率、操作者和患者的满意率均明显高于C组(P<0.01)。结论靶控输注异丙酚-瑞芬太尼用于老年人结肠镜检查能达到良好的清醒镇静镇痛麻醉效果,有效抑制应激反应,稳定血流动力学,缩短入镜时间,提高检查的成功率、患者的耐受性和依从性,是一种安全、有效、可行的麻醉方法。

Conscious sedation/analgesia with target-controlled propofol and remifentani for colonoscopy in elderly

Objective To study the efficacy and safety with conscious sedation/analgesia using target-controlled infusion (TCI) of propofol and remifentanil for colonoscopy in elderly. Methods Seventy elder candidates (ASA I-III) for colonoscopy were randomized into two groups (n=35 each): anesthesia group (group T) and control group (group C). Colonoscopy was started after Ramsay score > 2 was achieved. For group T, TCI was given with propofol maintained at 0.4 ~ 1.0μg/ml and remifentanil at 0.4~0.9 ng/ml, and was discontinued when colonoscope reached ileocecal valve. Group C underwent colonoscopy without anesthesia. Results 85.7% of patients in group T and 20% in group C achieved Ramsay score 2 (P<0.01). Compared with group C, group T showed lower visual analogue scales (VAS) (P<0.01), shorter operating duration, reduced SBP, DBP and HR at colonoscopy (P<0.05 or 0.01), lower BIS (P<0.01) but no elevation in blood sugar level (P<0.05). Higher success rate and percentage of satisfaction from patients and physicians were also noted in group T. Conclusion TCI with propofol/remifentanil for colonoscopy in the elderly may provide favorable outcomes in terms of conscious sedation/analgesia, hemodynamics, stress reaction, operative duration, success rate as well as patient acceptance and compliance. Therefore, this is a safe, effective and feasible option for anesthesia.