两种剂量雷米芬太尼复合丙泊酚用于无痛胃镜检查的观察探索

目的观察不同剂量雷米芬太尼复合丙泊酚在无痛胃镜检查中的效果及可行性。方法选择100例ASAⅠ～Ⅱ级无痛胃镜检查患者,随机分为两组。麻醉用药方案,A组：丙泊酚1.5mg/kg＋雷米芬太尼0.2μg/kg;B组：丙泊酚1.5mg/kg＋雷米芬太尼0.4μg/kg;检查期间体动则追加丙泊酚0.5mg/kg;观察并记录入室（T0）、给药后2min（T1）、入镜后2min（T2）、退镜（T3）、苏醒时刻（T4）、离院前（T5）时刻平均动脉血压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）以及内镜检查时间、苏醒时间、定向力恢复时间、离院时间、疼痛视觉模拟评分（VAS）和麻醉效果。结果所有患者麻醉后MAP、HR、SpO2下降,离院前回升,其中SpO2在T2时刻最低（P〈0.01）,分别为A组96.7%±2.8%、B组96.1%±3.6%。两组患者检查时间、苏醒时间、定向力恢复时间和离院时间均无显著性差异。B组麻醉效果明显优于A组（麻醉效果优占比96%vs.74%,P〈0.01）,呼吸抑制例数明显多于A组（发生SpO2低于90%例数比16%vs.0,P〈0.01）,但托下颌后均缓解。结论对于实施无痛胃镜检查的患者,采用丙泊酚1.5mg/kg联合雷米芬太尼0.4μg/kg实施静脉麻醉麻醉镇痛效果好,对呼吸循环抑制轻微,为较好的用药方案。

The clinical investigation of remifentanyl combined with propofol for painless gastroscopy

Objective To explore the effect and feasibility of different dosages of remifentanil combined with propofol for painless gastroscopy.Methods One hundred patients with ASA I-Ⅱundergoing gastroscopy were randomized into two Groups （Group A and Group B, n=50）.Patients in Group A were given propofol 1.5mg/kg and remifentanyl 0.2μg/kg by intravenous injection, and patients in Group B were given propofol 1.5mg/kg and remifentanyl 0.4μg/kg before gastroscopy insertion.The bolus propofol 0.5mg/kg was added intravenously if necessary.The MAP, HR, SpO2 were record-ed at 6 time-points：before induction （T0-）-2 minutes after induction; T1-2 minutes after gastroscopy insertion; T2-gastroscopy withdrawn; T3-awareness;T4-discharge（T5）.The operation time, awareness time, time of orientation recovery, hospital stay time, VAS scores and anesthetic effects were observed.Results Of all patients, the MAP, HR and SpO2 decreased after induction and recovered before discharge.The lowest SpO2 was observed in T2 （96.7±2.8）% in Group A vs.（96.1±3.6）% in Group B]（P0.01）.There were no statistical difference in operation duration, awareness, orientation recovery and hospital stay between the two groups.The anesthetic effects in Group B was better than Group A （P0.01）, and the spon-taneous breathing depression （SpO290%） was more common in Group B compared with Group A （16% vs.0%,P0.01）.Conclusions Propofol 1.5mg/kg and remifentanyl 0.4μg/kg can be used in patients undergoing painless gastroscopy, but clinician must pay special attention to the respiratory depression effect of this combination.