丙泊酚联合芬太尼作为肝硬化患者无痛胃镜检查镇静剂的临床效果观察
병박분연합분태니작위간경화환자무통위경검사진정제적림상효과관찰
Sedation with propofol plus fentanyl for cirrhotic patients during upper gastrointestinal endoscopy
  • 万方数据
    中华消化内镜杂志 중화소화내경잡지
    CHINESE JOURNAL OF DIGESTIVE ENDOSCOPY
    2012年 6期 311-315 ,共5页

    郑丰平%黎嘉妍%郭云蔚%陶力

    정봉평%려가연%곽운위%도력

    肝硬化%丙泊酚%内窥镜%肝性脑病%并发症 肝硬化%丙泊酚%內窺鏡%肝性腦病%併髮癥
    간경화%병박분%내규경%간성뇌병%병발증
    Liver cirrhosis%Propofol%Endoscopes%Hepatic encephalopathy%Complication
    目的 前瞻性探讨肝硬化患者无痛胃镜检查过程中应用丙泊酚联合芬太尼作为镇静剂的安全性和可行性.方法 肝硬化患者和非肝硬化患者各50例分别纳入肝硬化镇静组和非肝硬化镇静组,接受丙泊酚联合芬太尼镇静下的胃镜检查；另选择30例肝硬化患者进行传统胃镜检查.观察各组镇静前或检查前、检查开始后5min、检查开始后10 min和检查结束后1h患者的生命体征变化情况,分析镇静前或检查前、检查结束后4h数字连接试验A(NCT-A)及轨迹描绘试验(LTT)结果,汇总并发症发生情况.结果 肝硬化镇静组和非肝硬化镇静组镇静后血压、心率、呼吸频率和脉搏血氧饱和度均有不同程度的下降(P＞0.05或P＜0.05),至检查结束后1h各项监测指标可基本恢复(P＞0.05)；肝硬化镇静组总的并发症发生率为36％ (18/50),与非肝硬化镇静组的14％ (7/50)比较差异有统计学意义(P＜0.05),但低血压、心动过缓和低氧血症各并发症的发生率比较差异无统计学意义(P＞0.05)；肝硬化镇静组与肝硬化非镇静组无一例胃镜检查后出现临床型肝性脑病.肝硬化镇静组、肝硬化非镇静组前后两个观察时点NCT-A和LTT均较非肝硬化镇静组明显延长[镇静或检查前:(55.1 ±22.1)s、(58.6±23.1)s比(36.9 ±7.0)s,(98.6±33.1)s、(89.5±15.6)s比(81.4±13.6)s；检查结束后4h:(54.4±21.6)s、(58.3±22.4)s比(36.3 ±6.3)s,(88.4 ±30.6)s、(80.2±15.9)s比(71.8±12.0)s；P＜0.05],但肝硬化镇静组与肝硬化非镇静组比较差异均无统计学意义(P＞0.05)；各组内前后两个观察时点比较,NCT-A均无明显变化(P＞0.05),但LTT均明显缩短(P＜0.05),考虑与“学习效应”有关；NCT-A和LTT前后两个观察时点变化差值三组间比较差异均无统计学意义(P＞0.05).结论 丙泊酚联合芬太尼用于肝硬化患者胃镜检查的深度镇静是相对安全的,不会诱发或加重轻微肝性脑病,不会导致不可逆转的并发症.
    목적 전첨성탐토간경화환자무통위경검사과정중응용병박분연합분태니작위진정제적안전성화가행성.방법 간경화환자화비간경화환자각50례분별납입간경화진정조화비간경화진정조,접수병박분연합분태니진정하적위경검사；령선택30례간경화환자진행전통위경검사.관찰각조진정전혹검사전、검사개시후5min、검사개시후10 min화검사결속후1h환자적생명체정변화정황,분석진정전혹검사전、검사결속후4h수자련접시험A(NCT-A)급궤적묘회시험(LTT)결과,회총병발증발생정황.결과 간경화진정조화비간경화진정조진정후혈압、심솔、호흡빈솔화맥박혈양포화도균유불동정도적하강(P＞0.05혹P＜0.05),지검사결속후1h각항감측지표가기본회복(P＞0.05)；간경화진정조총적병발증발생솔위36％ (18/50),여비간경화진정조적14％ (7/50)비교차이유통계학의의(P＜0.05),단저혈압、심동과완화저양혈증각병발증적발생솔비교차이무통계학의의(P＞0.05)；간경화진정조여간경화비진정조무일례위경검사후출현림상형간성뇌병.간경화진정조、간경화비진정조전후량개관찰시점NCT-A화LTT균교비간경화진정조명현연장[진정혹검사전:(55.1 ±22.1)s、(58.6±23.1)s비(36.9 ±7.0)s,(98.6±33.1)s、(89.5±15.6)s비(81.4±13.6)s；검사결속후4h:(54.4±21.6)s、(58.3±22.4)s비(36.3 ±6.3)s,(88.4 ±30.6)s、(80.2±15.9)s비(71.8±12.0)s；P＜0.05],단간경화진정조여간경화비진정조비교차이균무통계학의의(P＞0.05)；각조내전후량개관찰시점비교,NCT-A균무명현변화(P＞0.05),단LTT균명현축단(P＜0.05),고필여“학습효응”유관；NCT-A화LTT전후량개관찰시점변화차치삼조간비교차이균무통계학의의(P＞0.05).결론 병박분연합분태니용우간경화환자위경검사적심도진정시상대안전적,불회유발혹가중경미간성뇌병,불회도치불가역전적병발증.
    Objective To prospectively study the safety and feasibility of sedation with propofol plus fentanyl for cirrhotic patients undergoing upper gastrointestinal endoscopy (UGIE).Methods A total of 50cirrhotic patients and 50 control subjects without liver diseases referred to UGIE were assigned to the cirrhotic sedation group and the non-cirrhotic sedation group,respectively.Patients of both groups received sedation with propofol plus fentanyl.Meanwhile,30 cirrhotic patients underwent conventional UGIE.Vital signs of all subjects were recorded before sedation and procedure,five minutes,ten minutes and one hour after the procedure.Number connection test A (NCT-A) and line tracing test (LTT) were completed for all patients before sedation or procedures and 4 hours after endoscopy procedures.Occurrence of sedation-related complications was measured.Results In the cirrhotic sedation group and the non-cirrhotic sedation group,blood pressure,heart rate,respiratory rate and saturation of pulse oximetry decreased of different degrees after secation (P ＞ 0.05 or P＜ 0.05),but returned to normal one hour after endoscopy procedures ( P ＞ 0.05).The total complication rates differed significantly between the cirrhotic sedation group and the non-cirrhotic sedation group [ 36％ (18/50) v.s.14％ (7/50),P ＜0.05 ].However,the rate of such complications as hypotension,bradycardia and hypoxemia in both groups was of no statistical difference (P ＞0.05 ).No cirrhotic patient developed overt hepatic encephalopathy after procedures.In addition,the NCT-A and LTT times before and after sedation in the cirrhotic sedation group and the cirrhotic non-sedation group were longer than those before and after procedure in the non-cirrhotic sedation group ( before sedation or procedure:(55.1 ±22.1)s,(58.6±23.1)s v.s.(36.9±7.0)s,(98.6±33.1)s,(89.5±15.6)s v.s.(81.4±13.6)s,P＜0.05; four hours after procedure:(54.4 ±21.6)s,(58.3 ±22.4)s v.s.(36.3 ±6.3)s,(88.4 ±30.6)s,(80.2 ±15.9)s v.s.(71.8 ± 12.0)s,P＜0.05,while there was no difference between cirrhotic sedation group and cirrhotic non-sedation group ( P ＞ 0.05 ).Within-group comparison showed NCT-A did not change ( P ＞ 0.05 ),whereas,LTT was obviously shorter than pre-sedation or pre-procedure ( P ＜ 0.05) due to "learning effect".The differences in the NCT-A and LTT times before and after sedation or procedure were not significant among the three groups (P ＞ 0.05 ).Conclusion Sedation with propofol plus fentanyl is relatively safe in cirrhotic patients during UGIE,which will not precipitate hepatic encephalopathy or cause irreversible complications.
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