摘要
目的比较瑞芬太尼与丙泊酚双通道靶控输注麻醉用于无痛小肠镜检查时,不同血浆靶浓度的瑞芬太尼联合相同血浆靶浓度的丙泊酚所产生的麻醉效果,及其对呼吸、循环等生命体征的影响,探讨两者双通道靶控输注用于无痛小肠镜检查的合理配方。方法 40例次需小肠镜(经口)检查患者,ASAⅠ～Ⅱ级,随机分为4组。4组分别输注瑞芬太尼0.2、0.4、0.6和0.8ng/mL,待瑞芬太尼达稳定血药浓度后,靶控输注丙泊酚3.0μg/mL。观察麻醉前(T0)、入睡睫毛反射消失时(T1)、入镜即刻(T2)、小肠镜经过曲氏韧带(T3)、检查结束出镜后(T4)时的平均动脉压(MAP)、心率(HR)、脉氧饱和度(SPO2)、BIS值以及诱导时间、唤醒时间和定向力恢复时间,记录呼吸抑制、体动、呛咳等不良反应发生情况。结果与麻醉前相比,4组入睡睫毛反射消失时MAP、HR、BIS均显著降低,Ⅰ组入镜及进镜经过曲氏韧带时MAP、HR、BIS均增高,Ⅲ组则与Ⅰ组相反;Ⅱ组睫毛反射消失时、进入曲氏韧带时MAP、HR、BIS和麻醉前比降低,入镜时MAP、HR、BIS较T1时升高;Ⅳ组各时间点MAP、HR、BIS较检查前均显著降低,Ⅰ、Ⅱ和Ⅲ组检查结束时MAP、HR和检查前比无显著性差异。Ⅰ组检查中的体动发生率显著增加;Ⅳ组呼吸抑制的发生率明显增加,4组诱导时间差异无显著性。唤醒时间及定向力恢复时间Ⅱ、Ⅲ和Ⅳ较I组间缩短,Ⅱ、Ⅲ和Ⅳ组间差异无显著性,4组苏醒时BIS差异无显著性。结论 3.0μg/mL丙泊酚复合0.6ng/mL瑞芬太尼,麻醉效果确切、检查中体动发生及呼吸抑制发生率低、清醒程度好,为小肠镜检查的一种安全有效的配方。
【Objective】To explore the reasonable compatibility of Remifentanil and Propofol during dual-channel target -controlled infusion for small intestinal enteroscopy,we used different target plasma concentration of Remifentanil combined the same target-controlled Propofol plasma concentrations resulting from anesthesia effectiveness and its impact on respiratory and circulatory function.【Methods】40 patients ASA Ⅰ～Ⅱ,requiring small intestinal enteroscopy were randomly divided into 4 groups,which were infused of Remifentanil 0.2,0.4,0.6 and 0.8 ng/mL respectively,when be up to the stability blood concentration,target-controlled infusion of Propofol 3.0 μg/mL.Observed the mean arterial pressure （MAP）,heart rate （HR）,pulse oxygenation （SPO2）,BIS at before anesthesia T0,disappearance of the eyelash reflex after sleeping T1 ,while the small intestine enteroscopy insertion T2 and passing through the Treitz ligament T3 and the end of examination after extraction T4,also recorded induction time,awakening time,orientation recovery time and the incidence of adverse effects such as patients’respiratory depression ,body motion and bucking.【Results】Compared with baseline values,MAP ,HR and BIS were significantly decreased in all groups when the eyelash reflex vanished;markedly increased in Group Ⅰ ,when the small intestinal en -teroscopy insertion and passed through the Treitz ligament,although not so obvious in Group Ⅲ;markedly increased in Group Ⅱ when the small intestinal enteroscopy insertion then T1;and greatly reduced at all time points in Group Ⅳ;Comparatively,the body motion in Group Ⅰincreased significantly and the respiratory depression were significantly increased in Group Ⅳ;the induction time was no significant difference;the awakening time and orientation recovery time of Group Ⅱ,Ⅲ,Ⅳ were shorter than GroupⅠ,and no significant difference in the other three groups.BIS at recovery time of four groups are no significant difference.【Conclusions】The compatibility program of 3.0 μg/mL propofol with 0.6 ng/mL Remifentanil which has good anesthetic effect and low occurrence of body motion and respiratory depression,is a safe and effective compatibility program for small intestinal enteroscopy.
出处
《中国内镜杂志》
CSCD
北大核心
2010年第2期131-134,139,共5页
China Journal of Endoscopy
关键词
双通道靶控输注
小肠镜
异丙酚
瑞芬太尼
BIS
dual-channel target-controlled infusion
small intestinal enteroscopy
Propofol
Remifentanil
BIS
