不同劑量芬太尼對異丙酚用于高齡患者腸鏡檢查術(shù)誘發(fā)體動反應(yīng)的抑制作用及其藥效學(xué)的影響
發(fā)布時間：2018-09-09 13:04
【摘要】：【目的】探討不同劑量芬太尼對異丙酚用于高齡患者腸鏡檢查術(shù)誘發(fā)體動反應(yīng)的抑制作用及其藥效學(xué)的影響 【方法】擇期纖維結(jié)腸鏡檢查術(shù)患者90例，ASA分級Ⅱ或Ⅲ級，年齡75～89歲，體重指數(shù)19～27kg/m2,性別不限，采用隨機數(shù)字表法，將病人隨機分為3組（n＝30）：對照組（C組）和不同劑量芬太尼組(F0.5組、F1.0組）。采用血漿靶控（TCI）輸注異丙酚，三組第一例病人初始靶濃度為2.0μg/ml，血漿濃度和效應(yīng)室濃度達(dá)到平衡后，C組、F0.5組、F1.0組分別靜脈注射芬太尼0、0.5、1.0μg/kg（用生理鹽水稀釋至5ml），維持異丙酚預(yù)先確定的目標(biāo)濃度3分鐘后，對患者進(jìn)行改良鎮(zhèn)靜評分,隨即行纖維結(jié)腸鏡檢查術(shù)，擬退出腸鏡時停止TCI。按序貫法根據(jù)腸鏡檢查過程中是否出現(xiàn)體動反應(yīng)確定下一例患者的初始靶濃度，其相鄰濃度梯度比值為1.2。術(shù)中連續(xù)監(jiān)測MAP、HR、SpO2及AAI。記錄病人的改良鎮(zhèn)靜評分及鏡檢過程中的軀體反應(yīng)；記錄麻醉誘導(dǎo)前（T0）、檢查開始后即刻（T1）、結(jié)腸鏡至乙狀結(jié)腸（T2）、結(jié)腸鏡至回盲瓣（T3）、檢查結(jié)束時（T4）的效應(yīng)室濃度（EC）、平均動脈壓（MBP）、心率（HR）、脈搏血氧飽和度（SpO2）、聽覺誘發(fā)電位指數(shù)（AAI）。記錄檢查持續(xù)時間、蘇醒時間、離院時間、術(shù)中循環(huán)抑制、呼吸抑制發(fā)生情況、術(shù)中知曉、檢查過程中不適發(fā)生情況；記錄術(shù)后惡心、嘔吐、嗜睡、寒戰(zhàn)、腹脹、腹痛等不良反應(yīng)發(fā)生情況。各組抑制軀體反應(yīng)的丙泊酚半數(shù)有效效應(yīng)室濃度EC50及95%可信區(qū)間通過Dixon和Brownlee的序貫試驗方法記算得出；通過概率單位回歸分析(Probit analysis)計算各組抑制軀體反應(yīng)半數(shù)有效聽覺誘發(fā)電位指數(shù)（AAI50），P＜0.05為差異有統(tǒng)計學(xué)意義。 【結(jié)果】C組、F0.5組和F1.0組靶控輸注異丙酚抑制高齡患者纖維結(jié)腸鏡檢查期間軀體反應(yīng)EC50及其95%CI分別為3.08(2.78～3.42)、2.75(2.50～3.02)、2.05(1.98～2.13)μg/ml，呈遞減趨勢（P0.05）；抑制軀體反應(yīng)的AAI50分別為29、31和34,呈遞增趨勢（P0.05）；體動患者的體動前AAI值明顯高于未體動患者AAI值(P0.01)；體動患者體動后AAI明顯高于體動前AAI值(P0.01)；C組、F0.5組和F1.0組組內(nèi)體動患者OAA/S評分明顯高于未體動患者(P0.01)。與T0比，T1、T2、T3、T4各時刻的MBP和HR均明顯下降（P0.01）；與C組比，T1、T2、T3各時刻的MBP和HR均明顯下降（P0.05）；與F0.5組組比，T1、T2、T3各時刻的MBP和HR均明顯下降（P0.05）。與C組和F0.5組比較，F(xiàn)1.0組較少發(fā)生低血壓和心動過緩（P0.05)； C組、F0.5組、F1.0組分別有8、6、7例病人出現(xiàn)呼吸抑制；分別有4、6、9例病人出現(xiàn)術(shù)中知曉,但檢查過程中均無不適。F1.0組術(shù)后腹脹、腹痛評分明顯低于C組和F0.5組（P0.05）；F1.0組蘇醒時間、離院時間明顯低于C組和F0.5組（P0.05）；本研究期間所有病人未出現(xiàn)其他副反應(yīng)。 【結(jié)論】高齡患者纖維結(jié)腸鏡檢查術(shù)時,芬太尼聯(lián)合異丙酚效應(yīng)室靶控輸注,可使異丙酚抑制軀體反應(yīng)的EC50降低，，鎮(zhèn)靜深度變淺；復(fù)合芬太尼1μg/kg時血液動力學(xué)更穩(wěn)定，不良反應(yīng)減少。
[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 鹵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.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614
本文編號：2232457
[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 鹵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.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614
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