无痛胃镜检查时不同浓度羟考酮对丙泊酚ED_(50)/ED_(90)的影响
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摘要
目的评价无痛胃镜检查时不同浓度羟考酮对丙泊酚药效学的影响,并确定不同浓度羟考酮时丙泊酚的有效浓度。方法选取我院无痛胃镜检查患者64例,采用随机数字表法分为两组,O1组:羟考酮:0.05 mg/kg和O2组:羟考酮:0.1 mg/kg。对于O1组和O2组,首例患者丙泊酚初始靶控浓度为3.5μg/mL和3μg/mL。观察患者入镜时吞咽、呛咳、体动发生情况,并根据前例患者麻醉情况,决定次例患者丙泊酚靶控浓度。根据患者最终观察结果,采用保守回归统计分析分别计算得出各组丙泊酚的有效浓度,并观察相关不良反应。结果 O1组丙泊酚ED50为2.46(2.03～2.84)μg/kg,O2组丙泊酚ED_(50)为2.23(1.68～2.50)μg/kg。O1组ED_(90)为4.1μg/kg,O2组ED90为2.6μg/kg。O1组低血压发生率高于O2组。结论0.05 mg/kg和0.1 mg/kg羟考酮相比,后者可明显降低丙泊酚达峰浓度,更好的满足无痛胃镜麻醉需求。
Objective To explore the effects of different concentrations of oxycodone on pharmacodynamics of propofol during painless gastroscopy. Methods Totally 64 patients undergoing painless gastroscopy were divid-ed into O1 group with oxycodone(0.05 mg/kg)and O2 group with oxycodone(0.1 mg/kg). For both groups,the target-controlled concentration of propofol for the first patients was 3.5 μg/mL and 3 μg/mL respectively and the deglutition,choking cough and body movement of the patient when entering the mirror were observed,then the concentration of propofol target control for next patient was determined by the condition of the previous patient.According to the final observation results of the patients,the effective concentration of propofol in each group was calculated by conservative regression statistical analysis,and the related adverse reactions were observed.Results The ED50 of propofol in O1 group was 2.46(2.03 ～ 2.84)μg/kg and that in O2 group 2.23(1.68 ～ 2.50)μg/kg. The ED90 of propofol in O1 and O2 group was 4.1 μg/kg and 2.6 μg/kg,respectively. The incidence of hypotension in group O1 was higher than that in group O2. Conclusion Compared with 0.05 mg/kg hydrocodone,0.1 mg/kg hydrocodone can significantly reduce the peak concentration of propofol and better meet the needs of painless gastroscopy anesthesia.
Objective To explore the effects of different concentrations of oxycodone on pharmacodynamics of propofol during painless gastroscopy. Methods Totally 64 patients undergoing painless gastroscopy were divid-ed into O1 group with oxycodone(0.05 mg/kg)and O2 group with oxycodone(0.1 mg/kg). For both groups,the target-controlled concentration of propofol for the first patients was 3.5 μg/mL and 3 μg/mL respectively and the deglutition,choking cough and body movement of the patient when entering the mirror were observed,then the concentration of propofol target control for next patient was determined by the condition of the previous patient.According to the final observation results of the patients,the effective concentration of propofol in each group was calculated by conservative regression statistical analysis,and the related adverse reactions were observed.Results The ED50 of propofol in O1 group was 2.46(2.03 ～ 2.84)μg/kg and that in O2 group 2.23(1.68 ～ 2.50)μg/kg. The ED90 of propofol in O1 and O2 group was 4.1 μg/kg and 2.6 μg/kg,respectively. The incidence of hypotension in group O1 was higher than that in group O2. Conclusion Compared with 0.05 mg/kg hydrocodone,0.1 mg/kg hydrocodone can significantly reduce the peak concentration of propofol and better meet the needs of painless gastroscopy anesthesia.
引文
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[13]汪雪锋,柴小青,魏昕,等.羟考酮用于无痛宫腔镜检查的可行性[J].实用医学杂志,2018,34(17):2942-2945.
[14]谭志斌,谢宗源,杨超杰,等.不同剂量羟考酮对插入喉罩的丙泊酚Cp50的影响[J].实用医学杂志,2018,34(13):2232-2235.
[14]JOPPICH R,RICHARDS P,KELEN R,et al.Analgesic efficacy and tolerability of intravenous morphine versus combined intravenous morphine and oxycodone in a 2-center,randomized,double-blind,pilot trial of patients with moderate to severe pain after total hip replacement[J].Clin Therapeut,2012,34(8):1751-1760.
[15]GAMBUS P L,JENSEN E W,JOSPIN M,et al.Modeling the effect of propofol and remifentanil combinations for sedationanalgesia in endoscopic procedures using an Adaptive Neuro Fuzzy Inference System(ANFIS)[J].Anesthesia&Analgesia,2011,112(2):331-339.
[16]SAHINOVIC M M,STRUYS MMRF,ABSALOM A R.Clinical pharmacokinetics and pharmacodynamics of propofol[J].Clin Pharmacokinet,2018,57(12):1539-1558.
[18]岳伟,张丽,郭强.无痛苦胃肠镜技术应用十年分析[J].中华消化内镜杂志,2013,30(2):97-99.
[19]TANG D M,SIMMONS K,FRIEDENBERG F K.Anti-hypertensive therapy and risk factors associated with hypotension during colonoscopy under conscious sedation[J].J Gastrointestin Liver Dis,2012,21(2):165-170.
[2]LICHTENSTEIN D R,JAGANNATH S,BARON T H,et al.Sedation and anesthesia in GI endoscopy.[M].Selection in one-and two-locus systems/.Springer-Verlag,2015:205-216.
[3]OBARA K,HARUMA K,IRISAWA A,et al.Guidelines for sedation in gastroenterological endoscopy[J].Dig Endosc,2015,27(4):435-449.
[4]KIM M K,AHN S E,SHIN E,et al.Comparison of analgesic efficacy of oxycodone and fentanyl after total hip replacement surgery:A randomized controlled trial[J].Medicine(Baltimore),2018,97(49):e13385.
[5]LIU B,LIU Y,LI N,et al.Oxycodone regulates incision-induced activation of neurotrophic factors and receptors in an acute post-surgery pain rat model[J].J Pain Res,2018,11:2663-2674.
[6]GAMBUS P L,JENSEN E W,JOSPIN M,et al.Modeling the effect of propofol and remifentanil combinations for sedation-analgesia in endoscopic procedures using an Adaptive Neuro Fuzzy Inference System(ANFIS)[J].Anesthesia&Analgesia,2011,112(2):331-339.
[7]SPAANDER M C,BARON T H,SIERSEMA P D,et al.Esophageal stenting for benign and malignant disease:European Society of Gastrointestinal Endoscopy(ESGE)Clinical Guideline[J].Endoscopy,2016,48(10):939-948.
[8]REY J F,BEILENHOFF U,NEUMANN C S,et al.European Society of Gastrointestinal Endoscopy(ESGE)guideline:The use of electrosurgical units[J].Endoscopy,2010,42(9):764-772.
[9]中华医学会麻醉学分会.中国消化内镜诊疗镇静/麻醉的专家共识[J].国际麻醉学与复苏杂志,2014,30(9):920-927.
[10]田可耘,孙柯.右美托咪定复合小剂量丙泊酚在无痛胃镜检查中对患者生命体征及麻醉深度的影响[J].实用医学杂志,2013,29(23):3920-3922.
[11]王志仪,陈一丁,李文瑶,等.异丙酚复合不同药物在门诊无痛纤维支气管镜检查中的麻醉效果分析[J].第三军医大学学报,2014,36(13):1440-1441.
[12]PATINO M,GLYNN S,SOBERANO M,et al.Comparison of different anesthesia techniques during esophagogastroduedenoscopy in children:A randomized trial[J].Pediatric Anesthesia,2015,25(10):1013-1019.
[13]汪雪锋,柴小青,魏昕,等.羟考酮用于无痛宫腔镜检查的可行性[J].实用医学杂志,2018,34(17):2942-2945.
[14]谭志斌,谢宗源,杨超杰,等.不同剂量羟考酮对插入喉罩的丙泊酚Cp50的影响[J].实用医学杂志,2018,34(13):2232-2235.
[14]JOPPICH R,RICHARDS P,KELEN R,et al.Analgesic efficacy and tolerability of intravenous morphine versus combined intravenous morphine and oxycodone in a 2-center,randomized,double-blind,pilot trial of patients with moderate to severe pain after total hip replacement[J].Clin Therapeut,2012,34(8):1751-1760.
[15]GAMBUS P L,JENSEN E W,JOSPIN M,et al.Modeling the effect of propofol and remifentanil combinations for sedationanalgesia in endoscopic procedures using an Adaptive Neuro Fuzzy Inference System(ANFIS)[J].Anesthesia&Analgesia,2011,112(2):331-339.
[16]SAHINOVIC M M,STRUYS MMRF,ABSALOM A R.Clinical pharmacokinetics and pharmacodynamics of propofol[J].Clin Pharmacokinet,2018,57(12):1539-1558.
[18]岳伟,张丽,郭强.无痛苦胃肠镜技术应用十年分析[J].中华消化内镜杂志,2013,30(2):97-99.
[19]TANG D M,SIMMONS K,FRIEDENBERG F K.Anti-hypertensive therapy and risk factors associated with hypotension during colonoscopy under conscious sedation[J].J Gastrointestin Liver Dis,2012,21(2):165-170.