瑞芬太尼对老年无痛肠镜中靶控输注丙泊酚用量的影响

目的:探讨在老年患者无痛肠镜麻醉中给予0.3μg/kg瑞芬太尼对丙泊酚TCI麻醉效能的影响。方法:将60例门诊无痛肠镜老年患者随机分为丙泊酚TCI组(P组,n=30)、瑞芬太尼复合丙泊酚TCI组(RP组,n=30)。RP组给予瑞芬太尼0.3μg/kg,P组给予生理盐水0.1ml/kg,然后按序贯法,两组依次给予不同剂量的丙泊酚计算出50%患者肠镜检查时无逃避性体动的丙泊酚血浆浓度(Cp50)。麻醉过程中连续监测患者心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(SpO2)、反应熵(RE)和状态熵(SE)。结果:①RP组与P组Cp50分别为3.425μg/ml和5.011μg/ml;②与P组比较,RP组丙泊酚总量和所有患者完成检查时丙泊酚血浆浓度显著减少(P<0.01);③RP组在肠镜检查过程中RE和SE值均显著高于P组(P<0.01)。结论 :在老年患者无痛肠镜麻醉中给予0.3μg/kg瑞芬太尼可以显著减少靶控输注丙泊酚的半数有效血浆浓度,在较浅麻醉深度下就能满足肠镜检查的需要。

Influence of a remifentanil bolus on the dosage of propofol during target-controlled infusion in propofol-anesthetized painless colonoscopy of elderly patients

Objective: To evalate the effect of remifentanil(0.3μg/kg) bolus on the efficacy of propofol during target-controlled infusion(TCI) in propofol anesthetized painless colonoscopy of elderly patients.Methods: Sixty elderly patients undergoing painless colonoscopy were randomly divided into two groups: propofol group(group P,n=30) and propofol plus remifentanil group(group RP,n=30).Remifentanil was given 0.3μg/kg in group RP.In group P liquor sodium chloride isotonicus was given 0.1ml/kg,then connected TCI injection pump.Patients were sequentially given different doses propofol so that 50% target propofol plasma concentration(Cp50 which there was a 50% chance that patients showed no movement in response for colonoscopy) could be determined by up-and-down sequential test.Heart rate(HR),mean arteria pressure(MAP),pluse oxygen saturation(SpO2),state entropy(SE),and response entropy(RE) were continuously monitored during anesthesia.Results: In group RP,propofol consumption and target propofol plasma concentration(Cp) were less than those in group P(P<0.01).Cp50 was 3.425μg/ml vs 5.011ug/ml in group RP and group P.RE and SE of group RP were significantly higher than those of group P(P<0.01) during anesthesia.Conclusion: Remifentanil 0.3μg/kg bolus can effectively decrease Cp50 values for TCI propofol and anesthetic sedation,and it’s safe for the elderly patients accepting the painless colonoscopy.