2018 年第 2 期 第 13 卷

复合丙泊酚时纳布啡用于无痛肠镜检查术患者麻醉的适宜剂量

作者：彭栋梁王晓娜杨军

英文作者：

单位：450008郑州，河南中医药大学第三附属医院麻醉科

英文单位：

关键词：纳布啡；丙泊酚；肠镜

英文关键词：

• 摘要：

• 目的    探讨复合丙泊酚时纳布啡用于无痛肠镜检查术患者麻醉的适宜剂量。方法    选取2016年6月至2017年5月于河南中医药大学第三附属医院内镜中心拟择期行无痛肠镜检查术的住院患者120例。采用随机数字表法分为4组：纳布啡0.05 mg/kg复合丙泊酚组(N1组)、纳布啡0.10 mg/kg复合丙泊酚组(N2组)、纳布啡0.15 mg/kg复合丙泊酚组(N3组)和芬太尼1 μg/kg复合丙泊酚组(F组)，每组30例。麻醉后行无痛肠镜检查术。分别于患者麻醉前5 min (T0)、睫毛反射消失时(T1)、检查开始即刻(T2)、镜身过脾曲时(T3)、镜身过肝曲时(T4)、术毕时(T5)记录患者收缩压、舒张压、心率和脉搏血氧饱和度(SpO2)。记录丙泊酚诱导用量、维持用量、总用量、总用药时间及单位时间用量。记录肠镜检查时间、苏醒时间和苏醒时疼痛数字评分量表(NRS)评分，记录术中体动反应、低氧血症、窦性心动过缓和低氧血症及麻醉恢复期头晕、恶心呕吐等不良反应发生情况。结果    4组间各时点收缩压、舒张压和心率差异无统计学意义(P>0.05)。N2组、N3组丙泊酚诱导用量、总用量、单位时间用量及NRS评分均低于F组(P<0.05)；N1组、N2组和N3组麻醉苏醒时间均短于F组(P<0.05)。N2组、N3组丙泊酚诱导用量、总用量、单位时间用量和NRS评分低于N1组，麻醉苏醒时间短于N1组［（106±13）、（82±12）mg(1 mmHg=0.133 kPa)比（130±15）mg，（268±17）、（223±12）mg比（322±19）mg，（14.2±2.5）、（12.1±2.9）mg/min比（17.6±2.2）mg/min，2(1，3)、1(0，1)分比4(2，5)分，（2.6±1.2）、（3.4±1.6）min比（4.4±1.6）min］(P<0.05)。N3组丙泊酚诱导用量、总用量均低于N2组(P<0.05)。4组患者术中体动反应、窦性心动过缓、低血压及麻醉恢复期恶心呕吐的发生率比较差异均无统计学意义(均P>0.05)。N3组低氧血症发生率高于F组、N1组和N2组，头晕发生率高于F组，差异均有统计学意义(均P<0.05)。结论    对于无痛肠镜检查术患者而言，纳布啡配伍丙泊酚能获得较好的麻醉效果，其适宜剂量为0.10 mg/kg。

• Optimum dose of nalbuphine combined with propofol in painless colonoscopy

  Peng Dongliang, Wang Xiaona, Yang Jun

  Department of Anesthesiology, Third Affiliated Hospital of Henan College of Traditional Chinese Medicine, Zhengzhou 450008, China

  Corresponding author: Peng Dongliang, Email: pengdliang07@163.com

  【Abstract】Objective    To explore the optimum dose of nalbuphine combined with propofol in painless colonoscopy. Methods    A total of 120 patients undergoing  painless colonoscopy from June 2016 to May 2017 in Third Affiliated Hospital of Henan College of Traditional Chinese Medicine were randomly divided into 4 groups(n=30): group N1 had 0.05 mg/kg nalbuphine plus propofol anesthesia, group N2 had 0.10 mg/kg nalbuphine plus propofol anesthesia, group N3 had 0.15 mg/kg nalbuphine plus propofol anesthesia, group F had 1 μg/kg fentanyl plus propofol anesthesia. Systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR) and blood oxygen saturation were recorded 5 min before anesthesia(T0), when eyelash reflex disappeared(T1), at the beginning of examination(T2), during the len of colonoscopy passing splenic flexure(T3), during the len of colonoscopy passing hepatic flexure(T4) and at the end of examination(T5). Dosage of propofol, duration time of enteroscopy, recovery time, score of the Numerical Rating Scale(NRS) for pain, occurrences of intraoperative reactions（body movement, hypoxemia, sinus bradycardia, hypotension）and anesthesia recovery reactions（dizziness, nausea, vomiting） were analyzed. Results    SBP, DBP and HR showed no significant differences among 4 groups during examination(P>0.05). Induction dosage, total dosage, 1 min dosage of propofol and the NRS score in group N2, N3 were significantly lower than those in group F(P<0.05); anesthesia recovery time in group N1, N2, N3 was significantly shorter than that in group F(P<0.05). Induction dosage, total dosage, 1 min dosage of propofol and the NRS score in group N2, N3 were significantly lower and anesthesia recovery time was shorter than those in group N1［（106±13），（82±12）mg vs（130±15）mg; （268±17）,（223±12）mg vs （322±19）mg; （14.2±2.5）,（12.1±2.9）mg/min vs （17.6±2.2）mg/min; 2(1，3), 1(0，1)scores vs 4(2，5)scores; （2.6±1.2）, （3.4±1.6）min vs （4.4±1.6）min］(P<0.05). Induction dosage and total dosage of propofol in group N3 were significantly lower than those in group N2(P<0.05). Incidences of body movement, sinus bradycardia, hypotension, nausea and vomiting showed no significant differences among groups(P>0.05). Incidence of hypoxemia in group N3 was significantly higher than that in group F, N1 and N2(P<0.05). Incidence of dizziness in group N3 was sighificantly higher than that in group F (P<0.05). Conclusion    Nalbuphine 0.10 mg/kg is considered to be the optimum dose for anesthesia with propofol in painless colonoscopy.

  【Key words】Nalbuphine;Propofol;Colonoscopy