氯胺酮和瑞芬太尼分别伍用丙泊酚用于无痛肠镜的临床比较

目的 比较氯胺酮和瑞芬太尼分别伍用丙泊酚全麻面罩通气用于无痛肠镜检查的临床效果.方法 拟行无痛肠镜检查的患者80例,随机分为2组（n=40）：（1）氯胺酮伍用丙泊酚组（KP组）：静注氯胺酮2mg/kg＋丙泊酚2 mg/kg; （2）瑞芬太尼伍用丙泊酚（RP组）：静注瑞芬太尼0.5 μg/kg＋丙泊酚2 mg/kg.2组均持续面罩吸氧,如术中出现体动反应给予丙泊酚1～2 mg/kg.监测患者给药前（T1）、给药后（T2）、置入肠镜时（T3）、检查5 min时（T4）、检查结束时（T5）的心率（HR）、呼吸频率（RR）、平均动脉压（MAP）和氧饱和度（SpO2）,并观察记录术后唤醒时间、恢复正常行走时间以及体动、呼吸暂停、喉痉挛等不良反应的发生率.结果 所有患者顺利完成肠镜镜检查,未出现体动反应、恶心呕吐、呼吸抑制、喉痉挛、肌肉僵直等不良反应;2组患者在5个时间点HR、RR、MAP、SpO2的差异无统计学意义（P＞0.05）;KP组患者的术后唤醒时间和恢复正常行走时间明显长于RP组（P＜0.05）;KP组苏醒期有8例出现烦躁.结论 氯胺酮和瑞芬太尼分别伍用丙泊酚均可有效的运用于肠镜检查手术,瑞芬太尼伍用丙泊酚可减少不良反应的发生,同时缩短恢复时间.

Clinical Observation of Ketamine-Propofol and Remifentanil-Propofol in Painless Colonoscopy

Objective To evaluate the efficacy and safety of the combinations of ketamine-propofol and remifentanil-propofol in painless colonoscopy.Methods 80 out-patients prepared to be examined by painless colonoscopy,ASA ASA Ⅰ-Ⅱ,were randomly divided into two groups （n =40）：（1） group KP：propofol 2 mg/kg and ketamine 2 mg/kg were infused; （2） group RP：propofol 2 mg/kg and remifentanil 0.5 μ g/kg were infused.Each patient should mask oxygen all the time.Propofol 1-2 mg/kg was added if there was a body dynamic response.The heart rate （HR）,respiratory rate （RR）,mean arterial pressure （MAP） and oxygen saturation （SpO2） were monitored at the time of before delivery （T1）,after the treatment （T2）,the time of colonoscopy placement （T3）,check the 5 min （T4）,and at the end of the inspection （T5）.And the time to wake up,time to walk back as normal,the incidence of adverse reactions were recorded.Results There were no statistically significant differences in HR,RR,MAP and SpO2 between the two groups （P＞ 0.05）.The time to wake up and to walk back as normal in KP group were significantly longer than those in RP group （P ＞ 0.05）,and there were 8 cases agitated during the awakening period in KP group.Conclusion The combination of ketamine-propofol and remifentanil-propofol can be effective in colonoscopy,while remifentanil-propofol is more satisfying because it can reduce the occurrence of adverse reactions and shorten the recovery time.