不同剂量阿芬太尼复合丙泊酚用于无痛胃镜检查中的效果观察

Clinical effect of different dosages alfentanil combined with propofol in painless gastroscopy

摘要:

目的 探讨不同剂量阿芬太尼复合丙泊酚用于无痛胃镜检查中的最佳剂量。方法 选择行无痛胃镜检查的患者120例，随机分为4组：静注阿芬太尼2.5 μg/kg组（O₁组，n = 30）、5.0 μg/kg组（O₂组，n = 30）、7.5 μg/kg组（O₃组，n = 30）和10.0 μg/kg组（O₄组，n = 30），2 min后缓慢注射丙泊酚1.5 mg/kg，改良警觉/镇静（MOAA/S）评分 ≤ 3分时开始行胃镜检查。记录胃镜检查时间、胃镜检查过程中患者发生体动次数、丙泊酚用量、丙泊酚追加次数和患者苏醒时间；记录诱导前（T₀）、诱导后MOAA/S评分 ≤ 3 分满足胃镜检查要求时（T₁）、胃镜通过咽喉部时（T₂）和检查结束胃镜撤出时（T₃）的平均动脉压（MAP）、心率（HR）和经皮动脉血氧饱和度（SpO₂）；记录并发症发生情况。结果 与O₁组和O₂组相比，O₄组体动次数和丙泊酚用量明显减少，苏醒时间明显缩短；与O₁组相比，O₃组体动次数明显减少。与O₁组相比，O₂组、O₃组和O₄组需要追加丙泊酚的患者数明显减少，与O₂组和O₃组相比，O₄组需要追加丙泊酚的患者数明显减少。与T₀时点相比，T₁～T₃时点4组患者MAP明显降低；与T₁时点相比，T₃时点O₃组和O₄组MAP明显升高；与T₀时点相比，T₁～T₃时点O₂组、O₃组和O₄组HR明显降低；与T₁时点相比，O₃组T₂和T₃时点HR明显升高，O₄组T₃时点HR明显升高；与T₀和T₁时点相比，T₂和T₃时点O₁组、O₂组和O₃组SpO₂明显降低；T₁和T₂时点，O₃组和O₄组MAP较O₁组明显降低；T₁时点，O₃组和O₄组HR较O₁组明显降低，O₄组HR较O₂组明显降低；T₂时点，O₄组HR较O₁组明显降低；T₃时点，O₄组SpO₂较O₁组明显升高（P < 0.05）。结论 10.0 μg/kg的阿芬太尼复合丙泊酚用于无痛胃镜检查，可以减少体动次数和丙泊酚用量，缩短苏醒时间，但其对血流动力学产生了抑制效应。

Abstract:

Objective To observe the effect of different dosages alfentanil combined with propofol in painless gastroscopy.Methods 120 patients underwent painless gastroscopy were selected. Patients were randomly assigned into four groups. Group O₁ received alfentanil 2.5 μg/kg intravenously (n = 30), group O₂ received alfentanil 5.0 μg/kg (n = 30), group O₃ received alfentanil 7.5 μg/kg (n = 30), group O₄ received alfentanil 10.0 μg/kg (n = 30). Patients in the four groups were given 1.5 mg/kg of propofol intravenously 2 min later, and painless gastroscopy was performed when the modified observer’s assessment of alert/sedation (MOAA/S) scale ≤ 3. The gastroscopy time, the condition of body movement during gastroscopy, the total dosage of propofol, the times of additional propofol and the awake time of patients were recorded. Mean arterial pressure (MAP), heart rate (HR) and percutaneous arterial oxygen saturation (SpO₂) were recorded before injection of test drug (T₀), when MOAA/S scale ≤ 3 to meet the requirements of gastroscopy after drug administration (T₁), gastroscopy passed through the throat (T₂) and gastroscope was removed after examination (T₃). And the complications rate were recorded.Result Compared with group O₁ and group O₂, the incidence of body movement and total dosage of propofol in group O₄ were significantly reduced, the awake time was significantly shortened, the incidence of body movement in group O₃ was significantly reduced; Compared with group O₁, the number of patients in group O₂、 O₃、 O₄ who need additional propofol was significantly reduced, and the number of patients in group O₄ who need additional propofol was significantly reduced compared with group O₂ and O₃. Compared with T₀, the MAP was significantly decreased at T₁~T₃ in four groups; Compared with T₁, the MAP of group O₃ and group O₄ were increased significantly at T₃. Compared with T₀, the HR of group O₂, group O₃ and group O₄ were significantly decreased at T₁ ~ T₃; Compared with T₁, the HR were significantly increased at T₂~T₃ in group O₃ and at T₃ in group O₄. Compared with T₀ and T₁, SpO₂ in group O₁, group O₂ and group O₃ were decreased significantly at T₂~T₃. At T₁ and T₂, the MAP of group O₃ and group O₄ were significantly decreased than that of group O₁. At T₁, the HR of group O₃ and group O₄ were significantly decreased than that of group O₁, and the HR of group O₄ was significantly decreased than that of group O₂; At T₂, the HR of group O₄ was significantly decreased than that of group O₁. At T₃, the SpO₂ of group O₄ was significantly increased than that of group O₁ (P < 0.05).Conclusion The 10.0 μg/kg alfentanil combined with propofol used for painless gastroscopy can reduce the incidence of body movement during gastroscopy and total dosage of propofol, shorten the awaking time, but it has inhibitory effect on hemodynamics.