不同剂量芬太尼对异丙酚用于高龄患者肠镜检查术诱发体动反应的抑制作用及其药效学的影响

发布时间：2018-09-09 13:04

【摘要】：【目的】探讨不同剂量芬太尼对异丙酚用于高龄患者肠镜检查术诱发体动反应的抑制作用及其药效学的影响【方法】择期纤维结肠镜检查术患者90例，ASA分级Ⅱ或Ⅲ级，年龄75～89岁，体重指数19～27kg/m2,性别不限，采用随机数字表法，将病人随机分为3组（n＝30）：对照组（C组）和不同剂量芬太尼组(F0.5组、F1.0组）。采用血浆靶控（TCI）输注异丙酚，三组第一例病人初始靶浓度为2.0μg/ml，血浆浓度和效应室浓度达到平衡后，C组、F0.5组、F1.0组分别静脉注射芬太尼0、0.5、1.0μg/kg（用生理盐水稀释至5ml），维持异丙酚预先确定的目标浓度3分钟后，对患者进行改良镇静评分,随即行纤维结肠镜检查术，拟退出肠镜时停止TCI。按序贯法根据肠镜检查过程中是否出现体动反应确定下一例患者的初始靶浓度，其相邻浓度梯度比值为1.2。术中连续监测MAP、HR、SpO2及AAI。记录病人的改良镇静评分及镜检过程中的躯体反应；记录麻醉诱导前（T0）、检查开始后即刻（T1）、结肠镜至乙状结肠（T2）、结肠镜至回盲瓣（T3）、检查结束时（T4）的效应室浓度（EC）、平均动脉压（MBP）、心率（HR）、脉搏血氧饱和度（SpO2）、听觉诱发电位指数（AAI）。记录检查持续时间、苏醒时间、离院时间、术中循环抑制、呼吸抑制发生情况、术中知晓、检查过程中不适发生情况；记录术后恶心、呕吐、嗜睡、寒战、腹胀、腹痛等不良反应发生情况。各组抑制躯体反应的丙泊酚半数有效效应室浓度EC50及95%可信区间通过Dixon和Brownlee的序贯试验方法记算得出；通过概率单位回归分析(Probit analysis)计算各组抑制躯体反应半数有效听觉诱发电位指数（AAI50），P＜0.05为差异有统计学意义。【结果】C组、F0.5组和F1.0组靶控输注异丙酚抑制高龄患者纤维结肠镜检查期间躯体反应EC50及其95%CI分别为3.08(2.78～3.42)、2.75(2.50～3.02)、2.05(1.98～2.13)μg/ml，呈递减趋势（P0.05）；抑制躯体反应的AAI50分别为29、31和34,呈递增趋势（P0.05）；体动患者的体动前AAI值明显高于未体动患者AAI值(P0.01)；体动患者体动后AAI明显高于体动前AAI值(P0.01)；C组、F0.5组和F1.0组组内体动患者OAA/S评分明显高于未体动患者(P0.01)。与T0比，T1、T2、T3、T4各时刻的MBP和HR均明显下降（P0.01）；与C组比，T1、T2、T3各时刻的MBP和HR均明显下降（P0.05）；与F0.5组组比，T1、T2、T3各时刻的MBP和HR均明显下降（P0.05）。与C组和F0.5组比较，F1.0组较少发生低血压和心动过缓（P0.05)； C组、F0.5组、F1.0组分别有8、6、7例病人出现呼吸抑制；分别有4、6、9例病人出现术中知晓,但检查过程中均无不适。F1.0组术后腹胀、腹痛评分明显低于C组和F0.5组（P0.05）；F1.0组苏醒时间、离院时间明显低于C组和F0.5组（P0.05）；本研究期间所有病人未出现其他副反应。【结论】高龄患者纤维结肠镜检查术时,芬太尼联合异丙酚效应室靶控输注,可使异丙酚抑制躯体反应的EC50降低，，镇静深度变浅；复合芬太尼1μg/kg时血液动力学更稳定，不良反应减少。
[Abstract]:[objective] to investigate the inhibitory effect of different doses of fentanyl on somatokinetic response induced by propofol in elderly patients with enteroscopy and its pharmacodynamics. [methods] 90 patients undergoing elective fibrocolonoscopy were studied. ASA grade II or III, The patients were randomly divided into three groups (n = 30): control group (group C) and fentanyl group with different doses (F0.5 group, F1.0 group). Propofol was injected with plasma target controlled (TCI). The initial target concentration of the first patient in the three groups was 2.0 渭 g / ml. After the balance between plasma concentration and response chamber concentration was reached, fentanyl 0. 5 渭 g/kg (diluted to 5ml with normal saline) was injected intravenously in F0. 5 and F1.0 group respectively, and the target concentration of propofol was maintained for 3 minutes. The patients were evaluated with modified sedation score, followed by fiberoptic colonoscopy, and TCI. was stopped when the patients were to withdraw from the colonoscopy. According to sequential method, the initial target concentration of the next patient was determined according to whether there was a volumetric response during enteroscopy, and the ratio of adjacent concentration gradient was 1.2. Continuous intraoperative monitoring of MAP,HR,SpO2 and AAI. The improved sedation score and somatic reaction were recorded. Before anesthesia induction (T0), immediately after the examination (T1), colonoscopy to sigmoid colon (T2), colonoscopy to ileocecal valve (T3), (EC), mean arterial pressure at the end of the examination (T4), (MBP), heart rate, (HR), pulse oxygen saturation (SpO2), auditory evoked potential index (AAI).) The duration of examination, the time of waking up, the time of absence from hospital, the occurrence of circulatory inhibition, respiratory depression, intraoperative knowledge, and discomfort during the examination were recorded, and the postoperative nausea, vomiting, drowsiness, shivering, abdominal distension, postoperative nausea, vomiting, somnolence, shivering and abdominal distension were recorded. Adverse reactions such as abdominal pain occurred. The EC50 and 95% confidence interval of propofol were calculated by the sequential test method of Dixon and Brownlee. The half effective auditory evoked potential index (AAI50) of somatic response was calculated by (Probit analysis) regression analysis (P < 0. 05). [results] the target controlled infusion of propofol in group C was significantly different from that in group F1.0 (P < 0. 05). The EC50 and 95%CI of somatic reaction were 3.08 (2.78 ~ 3.42) ~ 2.75 (2.50 卤3.02) ~ 2.05 (1.98 ~ 2.13) 渭 g / ml during the period of fibercolonoscopy in elderly patients, which showed a decreasing trend (P0.05). The AAI50 of inhibiting somatic response was 290.31 and 34respectively, which showed an increasing trend (P0.05). The AAI of patients with body movement was significantly higher than that of patients without body movement (P0.01), the AAI of patients with body motion was significantly higher than that of AAI before body movement (P0.01), and that of patients with body motion was significantly higher than that of patients without body movement (P0.01). The OAA/S score in group C was significantly higher than that in group C (P 0.01). Compared with T0, the MBP and HR of T1T2T2T3T4 decreased significantly (P0.01), the MBP and HR of T1T2T2T3 decreased significantly compared with that of group C (P0.05), and the MBP and HR of T1T2T2T3T4 decreased significantly compared with group F0.5 (P0.05). Compared with C group and F0.5 group, hypotension and bradycardia occurred less in F1.0 group (P0.05); C group, F0.5 group F0.5 group F1.0 group had respiratory depression in 7 cases, 4 cases had intraoperative knowledge, but there was no postoperative abdominal distention in F1.0 group. The abdominal pain score was significantly lower than that in group C and group F0.5 (P0.05), and the time of absence from hospital was significantly lower than that in group C and group F0.5 (P0.05). Fentanyl combined with propofol target-controlled infusion of propofol decreased the EC50 of somatic response and shrunk the sedation depth, and the hemodynamics was more stable and the adverse reaction was reduced when fentanyl was combined with fentanyl for 1 渭 g/kg.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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