靶控瑞芬太尼复合丙泊酚在纤维胃镜检查中的应用

纤维胃镜检查是上消化道疾病的一项基本检查,但不可避免造成病人的恐惧、焦虑与不适,镜检时的不良反应使患者痛苦,也给检查带来了一定的风险.笔者自2008～2010年将瑞芬太尼复合丙泊酚应用于纤维胃镜检查,镇静效果良好,麻醉效果确切,能有效抑制术中的不良反应,现报告如下.     

靶控输注丙泊酚复合瑞芬太尼全凭静脉麻醉在老年经输尿管镜气压弹道碎石手术中的应用

随着社会老年人口的增加,特别是社会生活方式的转变,老年人输尿管结石的发病率不断增加.手术碎石仍然是主要治疗手段,但由于老年人生理和病理的特点,对麻醉的耐受性较差,进而影响手术疗效及康复.瑞芬太尼是一种新型的速效阿片类镇痛药,具有起效快,体内清除快且代谢不受肝、肾影响等特点,用于全麻诱导和全麻中维持镇痛[1].丙泊酚也是一种新型快速、短效静脉麻醉药,具有麻醉诱导起效快、苏醒迅速且功能恢复完善,术后恶心呕吐发生率低等优点[2].本研究探讨瑞芬太尼复合靶控输注丙泊酚全凭静脉麻醉对老年经输尿管镜气压弹道碎石手术患者的效果,为临床应用提供参考.     

丙泊酚复合瑞芬太尼靶控静脉麻醉与静吸复合麻醉在老年颅内肿瘤患者手术中的比较

目的观察丙泊酚复合瑞芬太尼靶控静脉麻醉与静吸复合麻醉对老年颅内肿瘤患者手术中血液动力学与术后苏醒程度的影响。方法择期行颅内肿瘤手术患者40例,年龄>60岁,ASAⅠ~Ⅱ级,随机分为丙泊酚复合瑞芬太尼组(A组)和静吸复合全麻组(B组);A组采用丙泊酚复合瑞芬太尼全程静脉麻醉,B组采用静脉复合吸入异氟醚维持麻醉,每组20例。分别记录患者诱导时心率、血压、术毕停药后病人自主呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间,观察病人拔管后即刻、1h和24h的意识状态评分(OAAS评分)、认知功能评分(MMSE评分)。结果与A组比较,B组诱导时血压明显降低(P<0.05),心血管抑制发生率和插管反应发生率明显增加(P<0.05),麻醉后自主呼吸恢复时间、呼之睁眼时间、拔管时间无显著差异(P<0.05),定向力恢复时间和离室时间明显增加(P<0.05),拔管后即刻、离开手术室和拔管后1h的OAAS评分明显降低(P<0.05),拔管后1h的MMSE评分明显降低(P<0.05)。结论丙泊酚复合瑞芬太尼靶控静脉麻醉诱导平稳且苏醒完全,能够很好地抑制应激反应,维持血流动力学的稳定。     

丙泊酚、瑞芬太尼静脉泵注与靶控输注在神经外科手术中的应用比较

将80例择期行神经外科手术的患者随机分为两组。A组采用丙泊酚复合瑞芬太尼靶控输注全静脉麻醉;B组先采用丙泊酚与利多卡因、芬太尼复合静脉泵注,芬太尼量由高到低,手术结束前2h改为丙泊酚、瑞芬太尼静脉泵注;两组患者持续泵注阿曲库铵[0.25～0.3mg/（kg.h）]。记录围麻醉期血流动力学指标、麻醉药用量、麻醉后恢复情况及是否有术中知晓。结果显示,两组患者麻醉诱导后收缩压、舒张压均明显降低,心率减慢,气管插管前后两组无明显改变;手术结束后睁眼时A组心率、血压较B组增高（P〈0.05）,两组苏醒均较快,无延迟性呼吸抑制;异丙酚、瑞芬太尼用量A组明显多于B组（P〈0.05）,且A组拔管后均诉切口疼痛,B组无1例诉切口疼痛。认为丙泊酚复合芬太尼、瑞芬太尼静脉泵注麻醉诱导迅速且维持平稳,停药后患者清醒快,无延迟性呼吸抑制,且对气管导管耐受性好,术后镇痛好。     

靶控输注丙泊酚复合瑞芬太尼诱导对开颅手术患者血流动力学的影响

目的进一步提高开颅手术麻醉诱导的安全性。方法将50例ASAⅠ～Ⅲ级择期全麻颅脑手术患者随机分成观察组和对照组各25例,分别予瑞芬太尼和丙泊酚靶控输注及静脉推注,麻醉诱导气管插管。观察两组肌僵硬现象,意识消失时间,插管前及插管后1min动脉压、心率。结果两组均未发现肌僵硬现象,导时的动脉压及HR均明显低于基础值（P均〈0.05）;观察组意识消失时间明显短于对照组（P〈0.05）;观察组气管插管后MBP升高不明显,心率几乎未见升高,对照组MBP升高明显。结论靶控输注丙泊酚复合瑞芬太尼用于开颅手术麻醉诱导,能较好的消除气管插管反应,不良反应少。     

不同浓度瑞芬太尼复合丙泊酚靶控输注麻醉在脑瘫患儿选择性脊神经后根切断术中的应用

目的 观察比较不同浓度瑞芬太尼复合丙泊酚靶控输注用于小儿脑瘫SPR术的临床效果.方法 80例脑瘫患儿,在全身麻醉下行选择性脊神经后根切断术,随机分为1、2、3、4组,每组20例,麻醉诱导及维持均采用丙泊酚联合瑞芬太尼靶控输注,丙泊酚效应室浓度维持在4 μg/mL,行电刺激时1、2、3、4组瑞芬太尼效应室浓度分别为2、3、4、5 ng/mL,观察并记录电刺激前后患儿的心率、平均动脉压、BIS值并观察电刺激神经引起足背收缩的阈值,观察并记录患儿术中知晓情况及其他不良反应发生情况.结果 1组平均动脉压、心率电刺激前后比较有统计学差异（P均＜0.01）;2组平均动脉压电刺激前后比较有统计学差异（P＜0.01）;3、4组患儿电刺激前后平均动脉压、心率、BIS值变化不明显（P＞0.05）.患儿术中电刺激时均可顺利引出足背收缩,均无术中知晓及其他不良反应.结论 电刺激时浓度为4～5 ng/mL瑞芬太尼复合丙泊酚靶控输注静脉麻醉用于小儿选择性脊神经后根切断术可取得满意的麻醉效果,并能满足手术需要.     

CSI反馈调控丙泊酚复合瑞芬太尼靶控输注在无痛人流术中的应用

靶控输注系统(TCI)控制静脉麻醉已广泛应用于临床,但其标准化给药方式难以满足个体麻醉需要.麻醉意识深度指数(CSI)是检测大脑皮层麻醉镇静程度的敏感指标.     

在老年肿瘤患者麻醉中七氟烷复合瑞芬太尼靶控输注的应用研究

目的探讨在老年肿瘤患者麻醉中七氟烷复合瑞芬太尼靶控输注的应用效果。方法选取我院2018年12月-2019年6月收治的老年肿瘤患者64例,采用随机数字表法分为两组,各32例。对照组采用丙泊酚复合瑞芬太尼靶控输注,观察组采用七氟烷复合瑞芬太尼靶控输注,观察两组不同时间段心率、平均动脉压及不良反应发生率。结果观察组手术30 min、手术停止时心率、平均动脉压均高于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论应用七氟烷复合瑞芬太尼靶控输注效果较好,对心率、血压影响较小,减少不良反应发生。     

丙泊酚联合瑞芬太尼靶控输注对患者血流动力学及脑电双频指数的影响

目的探讨丙泊酚联合瑞芬太尼靶控输注对患者血流动力学及脑电双频指数(BIS)的影响。方法选取2013年11月至2014年11月该院行丙泊酚联合瑞芬太尼靶控输注麻醉患者90例,根据瑞芬太尼靶控输注的浓度将患者分为Ⅰ组(2.0 ng/ml)、Ⅱ组(3.0 ng/ml)和Ⅲ组(4.0 ng/ml),每组30例,三组丙泊酚的靶浓度均为4μg/ml。比较三组入室后5 min(T0)、插管前(T1)、插管后1 min(T2)、插管后3 min(T3)、插管后5 min(T4)时的心率(HR)、平均动脉压(MAP)以及BIS,并比较苏醒时间。结果 T2、T3、T4时刻Ⅲ组的BIS值显著低于Ⅰ组和Ⅱ组(P0.05);Ⅰ组在T2、T3时刻的HR、MAP均显著高于T1时刻,Ⅱ组在T2时刻HR、MAP显著高于T1时刻(P0.05);Ⅲ组苏醒时间显著长于Ⅰ组和Ⅱ组(P0.05)。结论丙泊酚联合瑞芬太尼靶控输注麻醉随着瑞芬太尼浓度的增加BIS值会降低,并且对血流动力学反应抑制作用也会增强。     

舒芬太尼和瑞芬太尼靶控输注静脉麻醉用于老年妇科腹腔镜手术的效果

目的探讨舒芬太尼和瑞芬太尼靶控输注静脉麻醉用于妇科腹腔镜手术的效果。方法 64例妇科腹腔镜手术患者,随机分为异丙酚(3 mg/ml)+瑞芬太尼(4.0 ng/ml)靶腔输注A组及异丙酚(3 mg/ml)+舒芬太尼B组(0.5 ng/ml),两组均为32例。输注舒芬太尼于术毕前20 min结束,且术毕时停止输注瑞芬太尼。观察两组的异丙酚使用量、血流动力学参数、复苏室停留时间、呼吸抑制发生率、术后恶心呕吐发生率及疼痛发生率。结果两组异丙酚使用量无统计学差异(P>0.05)。麻醉前的MAP基础值两组无显著差异(P>0.05),而麻醉后舒芬太尼组MAP均高于瑞芬太尼组(P<0.05)。瑞芬太尼组术后恶心呕吐发生率显著高于舒芬太尼组(P<0.05),复苏室停留时间也显著长于舒芬太尼组(P<0.05)。瑞芬太尼组术后疼痛发生率显著高于舒芬太尼组(P<0.05)。结论两种阿片类药物均能达到快捷麻醉的效果,而舒芬太尼可以发挥较显著的镇痛效能,能降低术后镇痛药物使用剂量,并能降低术后恶心呕吐发生率及疼痛发生率,使复苏室停留时间得以缩短。     

瑞芬太尼复合丙泊酚靶控输注麻醉用于肝部分切除术患者临床效果研究*

目的 探讨瑞苏太尼复合丙泊酚靶控输注(TCI)麻醉用于肝脏部分切除术(PHX)患者的麻醉效果。方法 2017年4月～2019年1月我院行PHX的原发性肝癌(PLC)患者86例,随机将患者分为研究组43例和对照组43例,给予对照组患者常规麻醉,给予研究组瑞芬太尼复合丙泊酚TCI麻醉,评价苏醒室标准(Aldrete)和改良警觉-镇静量表(OAA/S)评分。结果 研究组患者拔管时间为(12.7±3.3)min,呼之睁眼时间为(10.1±3.2)min,自主呼吸恢复时间为(9.4±2.1)min,均显著短于对照组【分别为(18.4±5.2)min、(17.6±3.4)min和(16.4±5.4)min,P<0.05】;在T0时,两组应激反应指标比较无显著性差异(P>0.05),但术中研究组应激反应指标水平整体优于对照组(P<0.05);拔管后即刻和拔管后15min,研究组患者Aldrete评分分别为(9.4±0.7)分和(9.4±0.8)分,OAA/S评分分别为(4.3±0.4)分和(4.7±0.4)分,显著高于对照组【分别为(8.3±0.4)分和(8.9±0.5)分,和(3.4±0.4)分和(4.2±0.5)分,P<0.05】;研究组不良反应发生率为11.6%,显著低于对照组的27.9%(P<0.05)。结论 应用瑞苏太尼复合丙泊酚TCI麻醉应用于PHX手术可有效减轻术中应激反应,提高术后苏醒效果,且具有较高的安全性,值得临床验证。     

异丙酚应用于结肠镜检查治疗术中的效果

目的　研究应用异丙酚作镇静麻醉用于结肠镜检查治疗术中的安全性、有效性和不良反应。方法　麻醉组 3 16例给予异丙酚静脉注射麻醉镇静结肠镜检查治疗 ,对照组 14 2例常规进行结肠镜诊疗 ,比较两组结肠镜操作时间及患者反应 ,观察麻醉组清醒时间及检查前、中、后血压、心率和血氧饱和度变化。结果　麻醉组 3 16例中 3 15例顺利完成检查 ,成功率 99.7% ,对照组 14 2例 ,13 6例完成检查 ,成功率为 95 8% ,两组比较有显著性差异 (P <0 .0 5)。麻醉组结肠镜到达回盲部的平均时间为 7 3± 1.4min ,对照为 12 .5± 1.6min(P <0 .0 5)。麻醉组患者清醒时间为 1min～ 8min。操作过程中均见一过性血压和心率下降 ,但检查结束后又恢复到原来水平。对照组操作过程中均有不同程度的血压升高 ,心率加快 ;两组操作前、中、后的SpO2 值无显著性差异 (P >0 .0 5)。结论　应用异丙酚作镇静麻醉于结肠镜检查治疗术安全有效 ,操作时间缩短 ,其不良反应明显低于常规结肠镜操作     

Target-controlled infusion during monitored anesthesia care in patients undergoing EUS: Propofol alone versus midazolam plus propofol: A prospective double-blind randomised controlled trial

BACKGROUND: It has been speculated that midazolam may be effective in reducing the required dose of propofol during sedation. AIM: To evaluate the sparing effect of midazolam during target-controlled propofol infusion. METHODS: Two hundred-seventy patients undergoing upper endoscopic ultrasound were randomised to receive sedation with propofol plus placebo (group A) or plus midazolam (group B). Outcome parameters were the procedure duration, the discharge time and the satisfaction of patients, operator and nurse about the quality of sedation. RESULTS: The mean propofol dose administered was 364+/-207 mg in group A and 394+/-204 mg in group B. Mean procedure duration (group A: 32+/-17 min, group B: 35+/-22 min) and discharge time (group A: 39+/-30 min, group B: 38+/-24 min) were similar in both groups. No severe complications were observed. The quality of sedation was judged satisfactory for all patients by both the endoscopist and the nurse assistant without any difference between the two groups. No patient remembered the procedure or reported it as unpleasant. CONCLUSIONS: Target-controlled propofol infusion provides safe and effective sedation; premedication with low dose of midazolam does not reduce the total amount of propofol administered. Further studies are needed to compare propofol alone with propofol co-administered with opioid.     

Feasibility of breath monitoring in patients undergoing elective colonoscopy under propofol sedation: A single-center pilot study

AIM: To determine whether a newly developed respiratory rate monitor can practically and accurately monitor ventilation under propofol sedation in combination with standard monitoring. METHODS: Patients [American Society of Anesthesiologists(ASA) Classification Ⅰ-Ⅲ] scheduled for elective colonoscopy under propofol sedation were monitored with a new device that measures the respiratory rate based on humidity in expired air. Patients with clinically significant cardiac disorders or pulmonary disease and patients requiring emergency procedures were excluded from study participation. All of the patients also received standard monitoring with pulse oximetry. This was a single-center study conducted in a community hospital in Switzerland. After obtaining written informed consent from all subjects, 76 patients(51 females and 25 males) were monitored during colonoscopy under propofol sedation. The primary endpoint was the occurrence of any respiratory event(apnea or hypopnea). Apnea was defined as the cessation of breathing for a minimum of 10 s. Significant apnea was defined as the cessation of breathing for more than 30 s. Hypopnea was defined as a reduction in the respiratory rate below 6/min for a minimum of 10 s. Any cases of significant apnea triggered interventions by the endoscopy team. The interventions included withholding propofol, verbal stimulation of the patients, and increased oxygen supplementation or the chin lift maneuver. A secondary endpoint was the correlation of apnea or hypopnea with hypoxemia(measured as a decrease in SaO2 of at least 5% from baseline or less than 90%). RESULTS: At least one respiratory event was detected in thirty-seven patients(48.7%). In total, there were 73 respiratory events, ranging from one to six events in a single patient. Significant apnea( 30 s) occurred in five patients(6%). Only one episode of apnea led to a relative SaO2 reduction(from 98% to 93%) after a 50 s lag time. No event requiring assisted ventilation was recorded. Our analysis revealed that the total propofol dose was an independent risk factor for respiratory events(P = 0.01). Artifacts developed with the same frequency with the new device as with conventional pulse oximetry. Compared with pulse oximetry alone, this new monitoring device detected more respiratory events and may provide earlier warning of impending respiratory abnormalities. CONCLUSION: Apnea commonly occurs during endoscopy under sedation and may precede hypoxemia. We recommend this respiration rate monitor as an alternative to capnography to aid in detecting ventilatory problems.     

Feasibilityof breathmonitoringin patientsundergoingelective colonoscopy under propofol sedation:A single-center pilot study简

AIM: To determine whether a newly developed respiratory rate monitor can practically and accurately monitor ventilation under propofol sedation in combination with standard monitoring.METHODS: Patients [American Society of Anesthesiologists (ASA) Classification I-III] scheduled for elective colonoscopy under propofol sedation were monitored with a new device that measures the respiratory rate based on humidity in expired air. Patients with clinically significant cardiac disorders or pulmonary disease and patients requiring emergency procedures were excluded from study participation. All of the patients also received standard monitoring with pulse oximetry. This was a single-center study conducted in a community hospital in Switzerland. After obtaining written informed consent from all subjects, 76 patients (51 females and 25 males) were monitored during colonoscopy under propofol sedation. The primary endpoint was the occurrence of any respiratory event (apnea or hypopnea). Apnea was defined as the cessation of breathing for a minimum of 10 s. Significant apnea was defined as the cessation of breathing for more than 30 s. Hypopnea was defined as a reduction in the respiratory rate below 6/min for a minimum of 10 s. Any cases of significant apnea triggered interventions by the endoscopy team. The interventions included withholding propofol, verbal stimulation of the patients, and increased oxygen supplementation or the chin lift maneuver. A secondary endpoint was the correlation of apnea or hypopnea with hypoxemia (measured as a decrease in SaO₂ of at least 5% from baseline or less than 90%).RESULTS: At least one respiratory event was detected in thirty-seven patients (48.7%). In total, there were 73 respiratory events, ranging from one to six events in a single patient. Significant apnea (> 30 s) occurred in five patients (6%). Only one episode of apnea led to a relative SaO₂ reduction (from 98% to 93%) after a 50 s lag time. No event requiring assisted ventilation was recorded. Our analysis revealed that the total propofol dose was an independent risk factor for respiratory events (P = 0.01). Artifacts developed with the same frequency with the new device as with conventional pulse oximetry. Compared with pulse oximetry alone, this new monitoring device detected more respiratory events and may provide earlier warning of impending respiratory abnormalities.CONCLUSION: Apnea commonly occurs during endoscopy under sedation and may precede hypoxemia. We recommend this respiration rate monitor as an alternative to capnography to aid in detecting ventilatory problems.     

Safety and effectiveness of propofol sedation during and after outpatient colonoscopy

AIM: To study the safety and effectiveness of propofol sedation for outpatient colonoscopy.METHODS: Propofol was given by bolus injection with an age-adjusted standard protocol consisting of 60 mg for patients < 70 years old, 40 mg for patients age 70-89 years, and 20 mg for those ≥ 90 years, and additional injections of 20 mg propofol were given up to a maximum of 200 mg. The principal parameters were the occurrence of adverse events within 24 h after colonoscopy and overall satisfaction for this procedure. Secondary parameters included successful procedure, respiratory depression, and other complications.RESULTS: Consecutive patients were entered prospectively and all 2101 entered successfully completed outpatient colonoscopy. The mean dose of propofol used was 96.4 mg (range 40-200 mg). Younger patients required higher doses of propofol than older patients (20-40 years vs ≥ 61 years: 115.3 ± 32 mg vs 89.7 ± 21 mg, P < 0.001). Transient supplemental oxygen supply was needed by five patients (0.2%); no other complications occurred. The questionnaires were completed by 1820 (87%) of 2101 patients and most rated their overall satisfaction as excellent (80%) or good (17%). The majority (65%) of patients drove home or to their office after their colonoscopy. Most (99%) were willing to repeat the same procedure. No incidents occurred within 24 h after colonoscopy.CONCLUSION: Propofol sedation using a dose < 200 mg proved both safe and practical for outpatient colonoscopy.     

Clinical study of anesthetization by dezocine combined with propofol for indolent colonoscopy

AIM: To assess the use of dezocine combined with propofol for the anesthetization of patients undergoing indolent colonoscopy.METHODS: A cross-sectional survey of patients undergoing indolent colonoscopy in the Xinjiang People’s Hospital was conducted from April 1 to April 30, 2015. The survey collected patient general information and anesthesia data, including overall medical experience and pain management. Thirty minutes after colonoscopy surgery, samples of venous blood were collected and the biochemical indicators of gastrointestinal function were analyzed.RESULTS: There were 98 female and 62 male respondents. Indolent colonoscopy was found to be more suitable for mid to older-aged patients. The necessary conditions for the diagnosis of digestive diseases were required in 65 of the 73 inpatients. Adverse reactions to the intraoperative process included two cases of body movement and two cases of respiratory depression. Gastrin and vasoactive intestinal peptide levels were slightly increased. However, somatostatin and endothelin levels were slightly decreased.CONCLUSION: This study revealed that dezocine combined with propofol can be successfully used for the anesthetization of indolent colonoscopy patients without pain and should be widely used.     

异丙酚联合芬太尼两种麻醉深度行无痛结肠镜检查的比较

目的比较异丙酚配伍芬太尼在两种麻醉深度下行无痛结肠镜检查的安全性、有效性及可行性。方法700例无禁忌症拟行无痛结肠镜检查的患者,随机分为两组,每组350例：A组（清醒无痛肠镜组）首次诱导剂量芬太尼0.5～1μg/kg,异丙酚0.5～1.5mg/kg,镇静程度根据Ramsay分级,麻醉深度为1～2级时停止给药,进镜至降乙移行部、脾区、肝区及其他肠腔弯曲角度较大的位置时追加药量。B组（睡眠无痛肠镜组）首次诱导剂量芬太尼0.5～1μg/kg,异丙酚1.5～2.5mg/kg,麻醉深度为3～4级时停止给药,进镜中发现患者有肢体运动及睫毛反射后追加药量。记录用药前2min、首次给药后2min、检查结束后2分min的HR、SpO2,记录术中异丙酚总量,入镜时间及恢复时间（检查结束至离院时间）、到达回盲部成功率、患者对检查的满意度。结果B组患者用药后2min心率、血氧饱和度均出现一定程度下降,组间、组内比较有显著性差异（P〈0.01）。A组异丙酚总量105.7±34.8mg,B组152.3±52.9mg,组间比较有显著性差异（P〈0.01）;入镜时间A组为15±5min,B组为21±7min,组间比较有显著性差异（P〈0.01）;恢复时间A组为6±2min,B组为15±4min,组间比较有显著性差异（P〈0.01）;A组检查成功率（到达回盲部）为99%,B组为98.5%,组间比较无显著性差异（P〉0.05）;对检查满意度A组为98.6%,B组为99.4%组间比较无显著性差异（P〉0.05）。结论清醒、睡眠两种不同麻醉深度下行无痛肠镜检查效果相同,清醒无痛肠镜能降低麻醉危险度、增加适应症、节约药物和时间、减少工作量,是一种安全、有效、可行的无痛肠镜检查方法。     

胃镜检查中泵输注与手控输注异丙酚麻醉效果的比较

目的以脑电双频指数(BIS)作为麻醉镇静深度的监测手段,比较泵输注与手控输注在胃镜检查中的麻醉效果,探讨泵输注异丙酚行静脉麻醉的安全有效剂量.方法美国麻醉医师学会建议的术前病人综合状况评级Ⅰ～Ⅱ级、行择期全麻胃镜检查病人48例,均分为泵输注(T)组和手控输注(M)组.两组均先静脉注射芬太尼1 μg/kg体重.T组异丙酚血药浓度从1 μg/ml开始,以0.5 μg/ml递增,待病人BIS值低于60后置入胃镜,镜检过程中血药浓度维持于2～3 μg/ml.M组异丙酚以4 g/h速度诱导,镜检过程中异丙酚4～6 mg·h-1·kg-1维持麻醉.镜检时以BIS 40～60之间来反馈调节麻醉深度.两组均于活检完成后停止输注.计算患者从麻醉诱导至镜检开始的时间(T1)、镜检持续时间(T2)、睁眼时间(T3)和检查室内总滞留时间(即定向力恢复并出院,T4);以及麻醉诱导用量(P1)、总用药量(P2)和平均输注速率(V).结果2组间T1差异有显著性(P=0.048),T2、T3、T4差异无显著性.M组P1和P2均高于T组,差异有显著性(P<0.01).2组间V差异无显著性(P=0.096).2组患者在镜检开始和睁眼时的BIS值基本相近(T和M分别为47.63±6.23和47.67±10.78;76.88±7.08和78.21±5.34).T组开始镜检时异丙酚的血浆浓度和脑内靶器官浓度分别为(4.25±0.94)μg/ml和(1.78±0.66)μg/ml;睁眼时的浓度分别为(1.34±0.39)μg/ml和(1.77±0.40)μg/ml.镜检过程中T组有3例病人出现不良反应,M组则有7例.结论胃镜检查中,BIS能较好地反映麻醉镇静程度,使用泵输注系统能更平稳地达到适宜的麻醉深度,降低麻醉药用量,减少不良反应的发生率.     

丙泊酚靶控输注应用于老年患者ERCP的安全性探讨

目的 评价丙泊酚靶控输注在老年患者内镜逆行胰胆管造影术（ERCP）中的应用价值；探讨该类患者ERCP操作过程中麻醉的处理。方法麻醉下行ERCP患者的2081例，根据年龄分成非老年组（1025例）和老年组（1056例），比较两组问操作过程中丙泊酚靶控输注血药浓度，血压变化，氧饱和度变化及不良事件发生率的差异。结果两组患者麻醉后血压、氧饱和度、心率均有所下降，两组间差异不明显，操作时老年组丙泊酚的血药浓度更低。两组问不良事件发生率没有差异没有统计学意义。结论通过完善的术前评价和准备，高龄患者麻醉下行ERCP是安全、可行的。