咽部麻醉下丙泊酚抑制胃镜咽喉反应半数有效剂量的研究

目的 通过序贯法研究咽部麻醉下丙泊酚抑制胃镜咽喉反应的半数有效剂量。方法 采用前瞻性研究方法,选取2019年12月至2020年1月于首都医科大学附属北京友谊医院门诊内镜中心拟行无痛胃镜检查的门诊患者22例,美国麻醉医师协会分级(ASA)Ⅰ~Ⅱ级,均监测平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(Sp O2)。丙泊酚用量自1. 6 mg/kg(第1例患者)开始,阶梯剂量为0. 1 mg/kg,患者的丙泊酚用量由前1例患者的咽喉反应确定,咽喉反应未抑制增加0. 1 mg/kg,咽喉反应抑制则减少0. 1 mg/kg,直至观察到“咽喉反应出现-咽喉反应抑制”这样的变化拐点8个,停止纳入患者。记录患者麻醉前、胃镜进镜、进镜后2 min、检查结束的MAP、HR、Sp O2变化,记录恶心呕吐、咳嗽呛咳、吞咽等咽喉反应。结果 丙泊酚抑制胃镜咽喉反应的半数有效剂量为1. 76 mg/kg(95%CI:1. 70~1. 85 mg/kg),MAP在麻醉前、胃镜进镜、进镜后2 min、检查结束时分别为(105. 05±13. 39) mm Hg、(89. 73±11. 32) mm Hg、(84. 45±10. 59) mm Hg、(79. 00±8. 36) mm Hg,给药后各观察点MAP较麻醉前明显降低(P <0. 05)。HR、Sp O2无明显变化。结论 通过序贯法确定咽部麻醉下丙泊酚抑制胃镜咽喉反应的半数有效剂量为1. 76 mg/kg(95%CI:1. 70~1. 85 mg/kg)。

Half effective dose of Propofol inhibiting pharyngeal response when inserting gastroscope under pharyngeal anesthesia

Objective To study the half effective dose of Propofol inhibiting pharyngeal response when inserting gastroscope under pharyngeal anesthesia by up and down method.Methods In this prospective study,22 outpatients scheduled for gastroscopy in outpatient endoscopy center Beijing Friendship Hospital,Capital Medical University from December 2019 to January 2020 were enrolled,American Society of Anesthesiologists class(ASA)Ⅰ~Ⅱ.The mean arterial pressure(MAP),heart rate(HR),peripheral pulse oxygen saturation(SpO 2)were monitored.The Propofol dose started at 1.6 mg/kg(the first patient),and the step dose was 0.1 mg/kg.The sequential dose given to the patient increased by 0.1 mg/kg if the pharyngeal response when inserting gastroscope of the previous patient was not considered inhibited or decreased by 0.1 mg/kg if the pharyngeal response was inhibited.The positive pharyngeal response-inhibited pharyngeal response was regarded as one crossover,and this study stopped at the eighth crossover.The change of MAP,HR and SpO 2 before anesthesia,at the time of inserting gastroscope,2 minutes after insertion and after gastroscopy was recorded.Nausea,vomiting,cough,and swallowing were also recorded.Results The half effective dose of propofol inhibiting pharyngeal response when inserting gastroscope was 1.76 mg/kg(95%Confidence Limits(CL)1.70-1.85 mg/kg).The MAP before anesthesia,at the time of inserting gastroscope,2minutes after insertion,and after gastroscopy was(105.05±13.39)mmHg,(89.73±11.32)mmHg,(84.45±10.59)mmHg,(79.00±8.36)mmHg,respectively.And MAP at the time of inserting gastroscope,2 min after insertion,and after gastroscopy decreased significantly(P<0.05).There was no significant change in HR and SpO 2.Conclusion Half effective dose of propofol for inhibiting pharyngeal response when inserting gastroscope under pharyngeal anesthesia was determined as 1.76 mg/kg(95%Confidence limits:1.70~1.85 mg/kg)by up-and-down method.