影响无痛胃镜丙泊酚用量的个体化因素分析

Analysis of individual factors that affecting dosage of propofol in painless gastroscopy

摘要:

目的 研究无痛胃镜中使丙泊酚用量明显增加和减少的个体因素，为提高个体化无痛胃镜的有效性和安全性提供参考。方法 纳入406例拟行无痛胃镜的患者，依次给予舒芬太尼0.10 μg/kg、丙泊酚1.00 mg/kg，随后采用滴定法追加丙泊酚，每次0.20 mg/kg，直至患者改良警觉/镇静评分（MOAA/S）=1分，然后行胃镜检查。记录并分析所有患者的信息和用药情况。丙泊酚的用量根据实际体重，以mg/kg计算，超过平均值的30%定义为用量增多，低于平均值的30%定义为用量减少。结果 在406例患者中，丙泊酚用量增加81例（19.95%）。其中，年龄 ≤ 35岁、重体力劳动或体育锻炼者、长期饮酒史和咽喉疾病患者丙泊酚用量明显增加（P < 0.05），经Logistic回归分析得出，以上4个因素与丙泊酚用量增加有关，OR＾值分别为10.211、2.749、3.266和4.406；丙泊酚用量减少36例（8.87%）。其中，年龄 > 65岁和肥胖患者的丙泊酚用量明显减少（P < 0.05），经Logistic回归分析得出，以上2个因素与丙泊酚用量减少有关，OR＾值分别为3.607和3.982。结论 有诸多个体因素导致无痛胃镜检查中丙泊酚较实际体重计算的用量增加或减少，提前识别这些个体因素，有利于个体化麻醉的实施。

Abstract:

Objective To study the individual factors that affecting the dosage of propofol in painless gastroscopy, and provide reference for improving the effectiveness and safety of individual painless gastroscopy.Methods 406 patients who were scheduled to undergo painless gastroscopy were given sufentanil 0.10 μg/kg and propofol 1.00 mg/kg successively. Followed by propofol titrating at 0.20 mg/kg each time until the patient's MOAA/S = 1, then gastroscopy was performed. The information and medication status of all patients were recorded and analyzed. The dosage of propofol that every patient used was calculated as mg/kg according to actual body weight, the dosage exceeding 30% of the average was defined as dosage increasing, and below 30% of the average was defined as dosage decreasing.Results The dosage increasing of propofol were in 81 cases (19.95%) among 406 patients, significantly in patients who were 35 years old or younger, hard physical laborers or exercisers, long-term drinkers, patients with throat diseases (P < 0.05). According to Logistic regression analysis that the four factors were associated with the dosage increasing, OR＾ values were 10.211, 2.749, 3.266 and 4.406, respectively. The dosage decreasing of propofol were in 36 cases (8.87%), significantly in patients who were aged greater than 65 years and obesity (P < 0.05). According to Logistic regression analysis, that the two factors were associated with the dosage decreasing, OR＾ values were 3.607 and 3.982, respectively.Conclusion There are many individual factors leading to the increase or decrease of propofol dosage that is calculated according to actual body weight in painless gastroscopy, and identifying these individual factors in advance is beneficial to the implementation of individual anesthesia.