低剂量地佐辛联合丙泊酚在老年患者无痛肠镜中的应用

目的探讨不同剂量地佐辛联合丙泊酚在老年患者无痛肠镜中的应用效果。方法 100例行无痛肠镜检查的老年患者,随机分为地佐辛20μg/kg联合丙泊酚组（D20组）、地佐辛40μg/kg联合丙泊酚组（D40组）、地佐辛60μg/kg联合丙泊酚组（D60组）、对照组为单纯丙泊酚组（C组）,每组各25例。所有患者静注丙泊酚1.5 mg/kg,术中必要时单次静脉追加丙泊酚20~50 mg。分别于注药前（T0）、睫毛反射消失（T1）、手术开始时（T2）、手术5 min（T3）、术毕（T4）及清醒时（T5）记录各组患者的平均动脉压（MAP）、脉搏血氧饱和度（SpO2）、心率（HR）和呼吸频率（RR）,记录各组患者丙泊酚的总用量、药物起效时间、术后苏醒时间、定向力恢复时间和术后疼痛视觉模拟评分（VAS评分）以及肠镜检查满意度和出院时间,观察各组患者不良反应情况。结果 4组患者在T1及T2时间点的MAP、HR和RR均显著低于同组T0时间点（P〈0.05）;C组在T2、T3时间点的MAP显著低于D40组、D60组的同时间点（P〈0.05）,追加的丙泊酚剂量显著高于D40组、D60组（P〈0.01）,体动、呛咳、呼吸抑制的发生率均显著高于D40组、D60组（P〈0.05）。4组患者均无术中知晓发生。所有患者对肠镜检查时的满意度为100%。结论地佐辛40~60μg/kg配伍丙泊酚1.5 mg/kg可安全用于门诊老年患者的无痛肠镜检查。

Application of low-dose dezocine combined with propofol for colonoscopy in elderly patients

Objective To compare the clinical outcomes in different dosages of dezocine combined with propofol for painless colonoscopy in elderly patients. Methods One hundred elderly patients undergoing colonoscopy were randomized into four groups（n=25 each）： dezocine 20 μg/kg combined with propofol（group D20）, dezocine 40 μg/kg combined with propofol（group D40）, dezocine 60 μg/kg combined with propofol（group D60）and propofol group（group C）. Propofol 1.5 mg/kg was injected intravenously in all patients. Additional propofol 20~50 mg was used if necessary. Mean arterial pressure（MAP）, saturation of blood oxygen（SpO2）, heart rate（HR）, and respiratory rate（RR） were recorded at each individual procedure time（T0 – T5）. The total usage of propofol, onset time, recovery time, recovery of orientation, postoperative VAS, anesthetic effect, hospital stay time and side effects were also recorded. Results The MAP, HR and RR at T1 and T2 were signifi cantly lower than at T0 in all patients（P〈0.05）. The MAP at T2, T3 in group C was signifi cantly lower than that at D40, D60 group（P〈0.05）. The dosage of propofol in group C was the largest（P〈0.01）. The incidence of body reaction, bucking and respiratory depression were significantly higher than those at D40,D60 group（P〈0.05）. No intraoperative awarenss occurred. All patients were satisfied with examination. Conclusion Dezocine 40~60 μg/kg combined with propofol 1.5 mg/kg is suitable for the elderly patients undergoing painless colonoscopy.