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目的研究靶控输注丙泊酚-瑞芬太尼清醒镇静镇痛用于结肠镜检查的有效性、安全性和可行性。方法60例AS(A美国麻醉医师协会)I、II级行结肠镜检查的患者,分为麻醉组(T组)和对照组(C组),每组30例,T组:丙泊酚血浆靶浓度0.5～1.2μg/mL、瑞芬太尼血浆靶浓度0.5～1.0ng/mL同时输注,待患者进入Ramsa(y镇静分级评分)2级开始镜检,肠镜抵达回盲部停止给药。C组:未用药。结果Ramsay评分:T组2级96.7%,C组1级100%(,P<0.01)。VAS(视觉模拟评分):T组明显小于C组(P<0.01)。T组入镜时间短于C组(P<0.05)。检查过程中:SBP、DBP、HR、LF、HF、L/H:C组明显上升(P<0.05,P<0.01);BIS:T组明显降低(P<0.01);血糖:C组升高(P<0.05)。T组检查成功率、操作者和患者的满意率、患者愿意再次接受检查率均明显高于C组(P<0.0)。结论靶控输注(TCI)丙泊酚-瑞芬太尼用于结肠镜检查能达到良好的清醒镇静镇痛麻醉效果,有效抑制应激反应,稳定血流动力学,缩短入镜时间,提高检查的成功率、患者的耐受性和依从性,是一种安全、有效、可行的麻醉方法。
Objective To study the efficacy, safety and feasibility of conscious controlled infusion of propofol-remifentanil for colonoscopy. Methods Sixty AS patients with stage I and II colonoscopy were divided into anesthesia group (T group) and control group (C group), 30 cases in each group. Group T: propofol plasma The target concentration of 0.5 ~ 1.2μg / mL, remifentanil plasma target concentration of 0.5 ~ 1.0ng / mL infusion at the same time, until the patient into the Ramsa (y sedation grade 2) began microscopic examination, enteroscopy to reach the ileocecal cease medicine. Group C: no medication. Results The Ramsay score was 96.7% in group T at level 2 and 100% at level 1 in group C (P <0.01). VAS (visual analogue scale): T group was significantly less than C group (P <0.01). T group into the mirror shorter than the C group (P <0.05). The levels of SBP, DBP, HR, LF, HF and L / H in C group were significantly increased (P <0.05, P <0.01) (P <0.05). The successful rate of T group examination, the satisfaction rate of the operator and the patient, and the willingness of the patients to accept the examination again were significantly higher than those in the C group (P <0.0). CONCLUSION TCI propofol-remifentanil can be used in colonoscopy to achieve a good anesthetic effect of conscious sedation and analgesia, effectively suppress stress response, stabilize hemodynamics, shorten the time of entering the mirror and increase The success rate of examinations, patient tolerance and adherence is a safe, effective and viable method of anesthesia.