老年人清醒镇静纤维结肠镜检查的临床观察

目的：探讨以联合靶控输注丙泊酚-瑞芬太尼清醒镇静用于老年人纤维结肠镜检查的安全性。方法：应用联合靶控输注丙泊酚血浆靶浓度为0.5-1.5μg/mL,瑞芬太尼血浆靶浓度为0.5ng/mL,对老年人行纤维结肠镜检查各40例。清醒镇静组术中双频谱指数（B IS）值保持在85±5,对照组BIS值保持在60±5,观察术前、术中、术后平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）变化及术中不良反应的发现情况。结果：清醒镇静组各时点HR、MAP、SpO2差异无显著性（P〉0.05）。对照组HR、MAP麻醉前与入镜、镜达回盲部差异有显著性（P〈0.05）,麻醉前与术毕差异无显著性（P〉0.05）,而SpO2各时点差异无显著性（P〉0.05）。清醒镇静组术中心律失常、舌后坠、呼吸暂停等不良反应明显减少（P〈0.05）。结论：联合靶控输注丙泊酚-瑞芬太尼以清醒镇静方式用于老年人纤维结肠镜检查比传统无痛方式更为安全。

Clinical Observation of Conscious Sedation in Elderly with Colonoscopy

Objective：To explore the safety of conscious sedation with target-controlled infusion of propofol and remifentanil for colonoscopy in elderly.Method： The plasma concentrations of target-controlled infusion of propofol was 0.5 ~ 1.5 μg/mL,the plasma concentrations of fentanyl was 0.5 μg/mL,80 cases were divided into conscious sedation group（n=40） and control group（n=40） in random.Bispectral index（BIS） in conscious sedation group 85±5,the BIS in control group maintain in 60±5.The preoperative,perioperative and postoperative mean arterial pressure（MAP）,heart rate（HR）,and pulse oxygen saturation（SpO2） were observed between two groups.The perioperative adverse reactions were recorded.Result： MAP,HR and SpO2 in every time point in conscious sedation group were no significantly different（P 0.05）.HR and MAP at the time point of preanesthesia,the beginning of endoscopy and reaching ileocecum in control group were significantly different（P 0.05）,and at the time point of preanesthesia and endoscopy finish were no significantly different（P 0.05）.SpO2 in every time point in control group was no significantly different（P 0.05）.the adverse reactions of arrhythmia,glossocoma,apnea in conscious sedation group decrease significantly（P 0.05）.Conclusion： The way of conscious sedation with target-controlled infusion of propofol and remifentanil for colonoscopy in elderly is safer than traditional painless way.