无阿片药麻醉对恶心呕吐高风险患者胃肠镜检查的效果

Efficacy of opioid-free anesthesia for gastrointestinal endoscopy in patients with high risk of nausea and vomiting

摘要:

目的 观察无阿片药物的麻醉方法在恶心呕吐高风险患者胃肠镜检查中的镇静效果。方法 该研究为前瞻性、双盲随机对照试验，选取2022年2月－2022年6月在该院行无痛胃肠镜检查的恶心呕吐高风险患者182例，美国麻醉医师协会（ASA）分级为Ⅰ级或Ⅱ级，通过分层随机分组，将患者分为丙泊酚-表面麻醉组（P组）和丙泊酚-舒芬太尼组（S组）。P组入室后静脉注射生理盐水0.1 mL/kg，使用奥布卡因凝胶进行表面麻醉，3 min后采用匀速静脉滴定的给药方式（速率4 mg/s），滴注丙泊酚至脑电双频指数（BIS） < 60，再行内镜检查；S组入室后静脉注射舒芬太尼（1.0 μg/mL）0.1 mL/kg，使用水溶性润滑剂行表面润滑，3 min后采用匀速静脉滴定丙泊酚诱导麻醉至BIS < 60，再行内镜检查。采用术后恶心呕吐（PONV）评分，评估PONV发生情况，观察并记录术中和术后不良事件的发生情况、血流动力学变化、麻醉总时间、恢复室停留时间和丙泊酚用量等。结果 与S组比较，P组PONV发生率和术后头晕发生率低，恢复室停留时间短，患者满意度高，差异均有统计学意义（P < 0.05）。结论 单用丙泊酚的无阿片麻醉，更适合用在恶心呕吐高风险患者胃肠镜检查的镇静中。

Abstract:

Objective To observe the effect of opioid-free anesthesia in the sedation of patients with high risk of nausea and vomiting during gastrointestinal endoscopy.Methods This study was a prospective double-blind randomized controlled trial, 182 patients (ASA gradeⅠ or Ⅱ) with high-risk of nausea and vomiting from February 2022 to June 2022 were selected. The patients were assigned to Propofol-surface anesthesia group (group P) and Propofol-Sufentanil group (group S). In group P, saline 0.1 mL/kg was injected intravenously, and then oxybuacaine gel was used for surface anesthesia. After 3 min, Propofol was injected by uniform intravenous titration (injection rate of 4 mg/s) until bispectral index (BIS) < 60, and then endoscopy was performed. In group S, Sufentanil (1.0 μg/mL) 0.1 mL/kg was injected intravenously, and then water soluble lubricants were used for surface lubrication. After 3 min, Propofol was injected intravenously at a constant rate to induce anesthesia until BIS < 60, and then endoscopy was performed. Postoperative nausea and vomiting (PONV) score was used to evaluate the occurrence of PONV in all the patients after operation. The intraoperative and postoperative adverse events, hemodynamic changes, total anesthesia time, stay time in recovery room and Propofol consumption were observed and recorded.Results Compared with group S, the incidence of PONV and postoperative dizziness in group P were decreased, the residence time in the post-anesthesia care unit was short, and the patients’ satisfaction was improved, the differences were statistically significant (P < 0.05).Conclusion Opiate-free anesthesia with Propofol alone is more suitable for sedation in patients with high risk of nausea and vomiting during gastrointestinal endoscopy.