摘要
目的分析ED95布托啡诺与舒芬太尼应用于无痛胃肠道内镜检查中的作用。方法收集2019-05-31-2020-07-31开封市人民医院124例行无痛胃肠道内镜检查患者的临床资料。根据麻醉方式不同,分为A组61例(ED95布托啡诺)和B组63例(舒芬太尼)。检查前30min肌内注射阿托品0.5mg,患者进入手术后建立静脉通路,并监测患者心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2)),使用面罩吸氧,准备麻醉剂以及相关急救物品。A组患者静脉推注ED95布托啡诺(1mg),B组静脉推注舒芬太尼(0.05mg),之后2组患者均静脉推注丙泊酚l~2mg/kg,至患者睫毛反射消失呼之不应,即可将内镜置入。在手术中以术中维持2~4mg/(kg·h)的速率使用输液泵推注丙泊酚,根据患者的HR、血压、体动反射情况对丙泊酚注射速度进行调整,以此维持麻醉深度。患者SpO_(2)<90%时,需要给予密闭面罩加压给氧,检查结束后可送至恢复室恢复。记录患者给药前(T_(0))、给药后2min(T_(1))、内镜置入时(T_(2))、内镜退出时(T_(3))HR、MAP和SpO_(2),观察苏醒时间、疲劳程度评分、检查时间、丙泊酚使用情况,评估停药后不同时间段Ramsay评分以及不良反应发生率。结果2组患者HR和MAP变化比较,不同时间段差异有统计学意义(HR:F_(时间)=5.965,P_(时间)=0.001;MAP:F_(时间)=84.032,P_(时间)<0.001),组间比较差异无统计学意义,时间和组间无交互作用,均P>0.05。2组患者SpO_(2)不同时间段(F_(时间)=299.709,P_(时间)<0.001)、组间(F_(组间)=38.811,P_(组间)<0.001)比较,差异均有统计学意义,SpO_(2)值和时间存在相互效应(F_(交互)=41.941,P_(交互)<0.001)。2组患者丙泊酚使用情况、检查时间、疲劳程度评分比较差异均无统计学意义,均P>0.05。A组苏醒时间为(6.56±1.55)min,长于B组的(5.18±1.36)min,t=5.274,P<0.05。停药5、10、20、25min时,A组Ramsay评分分别为(5.62±0.24)、(3.69±0.71)、(2.62±0.58)和(2.35±0.57)分,B组分别为(5.59±0.69)、(3.64±0.25)、(2.30±0.18)和(2.09±0.11)分,随着时间延长,Ramsay评分逐渐降低(F_(时间)=695.452,P_(时间)<0.001),2组差异有统计学意义(F_(组间)=7.616,P_(组间)=0.008),时间和组间无交互作用,P>0.05。A组发生循环抑制2例,头晕3例,B组发生循环抑制1例,头晕2例,差异无统计学意义,P>0.05;B组发生恶心/呕吐7例,高于A组的1例,差异有统计学意义,P=0.034。结论ED95布托啡诺与舒芬太尼应用于无痛胃肠道内镜检查均可获得良好效果,但ED95布托啡诺对患者呼吸抑制轻,对患者肠胃道影响少,安全性高,在麻醉安全与管理上更具优势。
Objective To analyze the effect of ED95 butorphanol and sufentanil in painless gastrointestinal endoscopy.Methods A total of 124 patients who underwent painless gastrointestinal endoscopy in our hospital from May 31,2019 to July 31,2020 were collected,according to different anesthesia methods,they were divided into 61 cases in group A(ED95butorphanol)and 63 cases in group B(sufentanil).Atropine 0.5mg was injected intramuscularly 30minutes before the examination,after the patient entered the operation,venous access was established,and the patient’s heart rate(HR),mean arterial pressure(MAP),and pulse oxygen saturation(SpO_(2))were monitored,used a mask to inhale oxygen and prepared for anesthesia and related first aid items.The group A was given intravenous injection of ED95butorphanol(1mg),and group B was given intravenous injection of sufentanil(0.05mg),both groups were given intravenous injection of propofol 1-2mg/kg until the eyelash reflex disappeared,if not,the endoscope could be inserted.During the operation,the infusion pump was used to inject propofol at a rate of 2-4mg/(kg·h),the injection speed of propofol was adjusted according to the patient’s HR,blood pressure,and body movement reflex to maintain the depth of anesthesia.When the patient’s SpO_(2)was less than 90%,a closed mask needed to be given pressurized oxygen,and it could be sent to the recovery room for recovery after the examination.Intraoperative HR,MAP,SpO_(2),recovery time,fatigue score,examination time,propofol usage.Ramsay score and adverse reaction rate at different time periods after drug withdrawal were recorded.Results There were statistically significant differences in HR and MAP changes between the two groups at different time periods(F_(HR time)=5.965,P=0.001;F_(MAP time)=84.032,P<0.001),there was no difference between the groups,and there was no interaction between time and groups(P>0.05).There were statistically significant differences in SpO_(2)between the two groups at different time periods and between groups,and there was an interaction between SpO_(2)value and time(F_(time)=299.709,F_(groups)=38.811,F_(interaction)=41.941,all P<0.001).There were no differences in the use of propofol,examination time and fatigue score between the two groups(P>0.05).The recovery time of group A was(6.56±1.55)min,which was longer than that of group B(5.18±1.36)min,t=5.274,P<0.05.At 5,10,20and 25minutes after drug withdrawal,Ramsay scores in group A were 5.62±0.24,3.69±0.71,2.62±0.58and2.35±0.57,respectively,and those in group B were 5.59±0.69,3.64±0.25,2.30±0.18and 2.09±0.11,respectively.With the extension of time,Ramsay scores gradually decreased(F_(time)=695.452,P_(time)<0.001).The difference between the two groups was statistically significant(F_(time)=7.616,P_(time)=0.008).There was no interaction between time and groups,P>0.05.There were 2cases of circulatory depression and 3cases of dizziness in group A,1case of circulatory depression and 2cases of dizziness in group B,the difference was not statistically significant,P>0.05.There were7cases of nausea/vomiting in group B,higher than 1case in group A,the difference was statistically significant,P=0.034.Conclusion ED95butorphanol and sufentanil have considerable effects in painless gastrointestinal endoscopy,but ED95 butorphanol has mild respiratory depression,less impact on patients’gastrointestinal tract,and high safety,which has more advantages in anesthesia safety and management.
作者
邱增亮
宋秀玲
林喻月
孙东东
QIU Zeng-liang;SONG Xiu-ling;LIN Yu-yue;SUN Dong-dong(Department of Pharmacy,Kaifeng People's Hospital,Kaifeng 475000,China)
出处
《社区医学杂志》
CAS
2022年第14期798-802,共5页
Journal Of Community Medicine
关键词
ED95布托啡诺
舒芬太尼
无痛胃肠道内镜
麻醉
呼吸抑制
ED95 butorphano
sufentanil
painless gastrointestinal endoscopy
anesthesia
respiratory depression
作者简介
通信作者:邱增亮,男,河南鹿邑人,主管药师,主要从事药学的基础与临床研究工作。E-mail:qiuzengliang1122@163.com
