小剂量咪达唑仑或氯胺酮用于酗酒患者无痛胃镜诊疗的临床研究
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摘要
目的探讨酗酒患者在无痛胃镜诊疗过程中安全有效的静脉全麻用药方案。方法选择山西省煤炭中心医院消化内科2017年3月至2017年10月拟行胃镜检查的酗酒患者120例,年龄25～65岁,ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为3组(每组40例):舒芬太尼组(S组):静脉注射舒芬太尼0.1μg/kg,丙泊酚1～2 mg/kg,依托咪酯0.1 mg/kg;咪达唑仑舒芬太尼组(MS组):此组在S组的基础上加入了咪达唑仑0.01 mg/kg;氯胺酮舒芬太尼组(KS组):此组在S组的基础上加入了氯胺酮0.1 mg/kg。三组的麻醉维持为静脉泵注丙泊酚10 mg/(kg·h)。记录术中低氧血症、呛咳和体动反应发生情况;记录术中发生低血压和血管活性药物的使用情况;记录苏醒时间。结果三组患者的年龄、性别、身高、体重、检查时间的差异无统计学意义(P>0.05)。与S组比较,MS组、KS组丙泊酚的总量少、呼吸抑制和低血压发生率低、体动和呛咳反应发生率低(P<0.01)。与MS组比较,KS组呼吸抑制和低血压发生率低。三组均苏醒快、清醒程度高(P>0.05)。结论小剂量咪达唑仑或氯胺酮复合舒芬太尼、丙泊酚和依托咪酯静脉麻醉方案可安全有效地用于酗酒患者的消化内镜诊疗过程。
Objective To explore the safe and effective intravenous anesthetic regimen for intemperants' painless endoscopy. Methods 120 cases of intemperants, aged 25-65 years old, ASA grade I orⅡ,were randomly divided into 3 groups(n =40) : sulfentanyl group(group S), midazolam and sulfentanyl group(group MS), ketamine and sulfentanyl group(group KS). Group S were intravenous injected with sufentanil 0. 1 μg/kg, propofol 1-2 mg/kg, etomidate 0. 1 mg/kg. Group MS and group KS were additional intravenous injected with midazolam 0. 01 mg/kg and ketamine 0. 1 mg/kg on the basis of Group S respectively. The occurrence of hypoxia, cough, body movement and blood pressure were recorded, the use of vasoactive drugs and the recovery time were also recorded. Results There are no statistical significant difference of age, gender, and testing time among the three groups( P > 0. 05). Compared with the group S, the total dose of propofol, the incidence of hypoxemia and hypotension, the incidence of body movement and cough reaction in group MS and group KS were all lower(P < 0. 01).And compared with the group MS, the patients have lower incidence of hypoxemia and hypotension in group KS(P<0. 05). All the patients were awake well(P > 0. 05). Conclusions Small doses of midazolam or ketamine combined with sulfentanyl, propofol and etomidate are safe and effective in the process of anesthesia during endoscopic diagnosis and treatment of intemperants.
Objective To explore the safe and effective intravenous anesthetic regimen for intemperants' painless endoscopy. Methods 120 cases of intemperants, aged 25-65 years old, ASA grade I orⅡ,were randomly divided into 3 groups(n =40) : sulfentanyl group(group S), midazolam and sulfentanyl group(group MS), ketamine and sulfentanyl group(group KS). Group S were intravenous injected with sufentanil 0. 1 μg/kg, propofol 1-2 mg/kg, etomidate 0. 1 mg/kg. Group MS and group KS were additional intravenous injected with midazolam 0. 01 mg/kg and ketamine 0. 1 mg/kg on the basis of Group S respectively. The occurrence of hypoxia, cough, body movement and blood pressure were recorded, the use of vasoactive drugs and the recovery time were also recorded. Results There are no statistical significant difference of age, gender, and testing time among the three groups( P > 0. 05). Compared with the group S, the total dose of propofol, the incidence of hypoxemia and hypotension, the incidence of body movement and cough reaction in group MS and group KS were all lower(P < 0. 01).And compared with the group MS, the patients have lower incidence of hypoxemia and hypotension in group KS(P<0. 05). All the patients were awake well(P > 0. 05). Conclusions Small doses of midazolam or ketamine combined with sulfentanyl, propofol and etomidate are safe and effective in the process of anesthesia during endoscopic diagnosis and treatment of intemperants.
引文
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[11]席宏,刘变英,李旭刚,等.三种联合用药方案用于重度肥胖患者胃镜诊疗麻醉效果的观察[J].中华胃肠内镜电子杂志,2017,4(1):10-13.DOI:10.3877/cma.j.issn.2095-7157.2017.01.003.
[2]张杨阳,崔常雷,孙瑛玮,等.酗酒对全麻用药和全麻并发症的影响[J].国际麻醉学与复苏杂志,2015,36(2):157-160.DOI:10.3760/cma.j.issn.1673-4378.2015.02.015.
[3]陈嘉生,梁超.长期饮酒对异丙酚使患者意识消失的半数有效效应室靶浓度的影响[J].中华麻醉学杂志,2011,31(1):25-27.DOI:10.3760/cma.j.issn.0254-1416.2011.01.008.
[4]郑文涛,孙振棣,刘振吉.右美托咪啶与咪达唑仑对于酗酒患者全身麻醉术后镇静的比较研究[J].中国医师进修杂志,2015,38(12):909-912.DOI:10.3760/cma.j.issn.1673 4904.2015.12.015.
[5]Bazov I,Kononenko 0,Watanabe H,et al.The endogenous opioid system in human alcoholics:m olecular adaptations in brain areas involved in cognitive control of addiction[J].Addict Biol,2011,18(1):161-169.DOI:10.1111/j.1369-1600.2011.00366.x.
[6]Nutt DJ.The role of the opioid system in alcohol dependence[J].J Psychopharmacol,2014,28(1):8-22.DOI:10.1177/0269881113504017.
[7]范涛,宣燕,华玉思,等.低风险饮酒对丙泊酚镇静效应的影响[J].临床麻醉学杂志,2011,27(8):752-754.
[8]Jirapinyo P,Thompson CC.Sedation Challenges:Obesity and Sleep Apnea[J].Gastrointest Endosc Clin N Am,2016,26(3):527-537.DOI:6666610.1016/j.giec.2016.03.001.
[9]Ljubicic N,Supanc V,Roic G,et al.Efficacy and safety of propofol sedation during urgent upper gastrointestinal endoscopy--a prospective study[J].Coll Antropol,2003,27(1):189-195.
[10]Bailey PL,Streisand JB,East KA,et al.Differences in magnitude and duration of opioid-induced respiratory depression and analgesia with fentanyl and sufentanil[J].Anesth Analg,1990,70(1):8-15.
[11]席宏,刘变英,李旭刚,等.三种联合用药方案用于重度肥胖患者胃镜诊疗麻醉效果的观察[J].中华胃肠内镜电子杂志,2017,4(1):10-13.DOI:10.3877/cma.j.issn.2095-7157.2017.01.003.