盐酸羟考酮用于无痛结肠镜检查的随机、双盲、对照研究

Oxycodone hydrochloride in painless colonoscopy: a randomized, double-blinded and controlled study

摘要:

比较丙泊酚分别复合羟考酮、芬太尼、舒芬太尼、地佐辛在结肠镜下息肉电切术中的麻醉效果及副作用。方法?选择无痛肠镜检查患者400例，随机分为4组：羟考酮组（O组）、芬太尼组（F组）、舒芬太尼组（S组）、地佐辛组（D组），每组100例。患者行检查前由护士随机给予4种实验药物的一种，体积均为0.1?ml/kg，5?min后给予丙泊酚2?mg/kg缓慢静脉推注。记录麻醉诱导时（T0）、肠镜进入肛门时（T1）、肠镜经过肝曲时（T2）、肠镜到达回盲部时（T3）、息肉电切时（T4）的脉搏血氧饱和度（SpO2）、心率（HR）和平均动脉压（MAP）；记录患者术中的体动例数、苏醒时间、恶心呕吐、头晕头痛和腹痛等不良反应的发生例数以及苏醒后视觉模拟评分（VAS）。结果?MAP比较：T1时所有患者较T0时均明显下降（P?<0.05）；T2、T3、T4时O组、F组、S组较T1时无明显变化（P?>0.05），D组较T1时明显升高（P?<0.05）。HR比较：T1时所有患者较T0时均明显下降（P?<0.05）；T2时O组、F组、S组较T1时无明显变化（P?>0.05），D组较T1时明显升高（P?<0.05）；T3时F组、S组、D组较T1时明显降低（P?<0.05）；T4时O组、F组、S组较T1时无明显变化（P?>0.05），D组较T1时明显升高（P?<0.05）。SpO2比较：所有患者各时间点组内比较差异无统计学意义。患者体动例数，D组较其他组明显升高，O组分别与F组和S组比较差异无统计学意义；呼吸抑制例数，F组、S组较其他组均有明显升高；苏醒时间，4组患者比较差异无统计学意义；术后恶心呕吐例数，O组明显低于其他3组；VAS评分，O组、F组、S组比较差异无统计学意义，D组明显高于其他组。结论?羟考酮、芬太尼、舒芬太尼、地佐辛分别复合丙泊酚应用于无痛肠镜检查均安全有效；羟考酮的呼吸抑制作用明显弱于芬太尼和舒芬太尼；应用羟考酮术后恶心呕吐发生率明显低于其他3组。

Abstract:

To compare the anesthetic effects and the side effects of propofol combined with fentanyl, sufentanil and dezocine respectively in painless colonoscopy examination.?Methods?Four hundred patients who were planned to undergo painless colonoscopy examination were enrolled; and randomly divided into 4 groups: oxycodone group (group O), fentanyl group (group F), sufentanil group (group S) and dezocine group (group D), 100 cases per group. The patients were given one of the experimental drugs: 50.0?μg/kg, 0.5?μg/kg, 0.1?μg/kg and 100.0?μg/kg respectively according to the group assignment. After 5 minutes, they were slowly given 2?mg/kg propofol intravenously. SpO2, HR and MAP were recorded at the following time point: the induction of anesthesia (T0), enteroscopy into the anus (T1), the colonoscopy (T2), the colonoscopy (T3), the polyps (T4). The number of body movement, wake-up time, nausea and vomiting, dizziness and headache, abdominal pain and other adverse reactions, as well as the VAS score, were recorded after the patient recovered consciousness.?Results?MAP comparison: all patients MAP were significantly lower at T0 than T1 (P??0.05). On the contrary, the group D was significantly higher at T2, T3, T4 than T1 (P??0.05); However, D group was significantly higher at T2 than T1 (P??0.05), But the group D was significantly higher at T4 than T1 (P?