中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2014年
6期
622-625
,共4页
王韬%高桂兰%朱亮先%王立勋%吴建魏
王韜%高桂蘭%硃亮先%王立勛%吳建魏
왕도%고계란%주량선%왕립훈%오건위
肠镜%Narcotrene 指数%异丙酚%麻醉深度
腸鏡%Narcotrene 指數%異丙酚%痳醉深度
장경%Narcotrene 지수%이병분%마취심도
Colonoscopy%Narcotrene ineex%Propofol%Anesthesia eepth
目的: Narcotrene 指数(Narcotrene ineex,NI)指导异丙酚联合不同镇痛药物在肠镜的检查,评估不同的镇痛药物的应用效果和安全性。依据 NI 指导的麻醉深度,调整肠镜检查时异丙酚的效应室浓度。方法240例门诊肠镜诊疗患者,根据异丙酚联合不同镇痛药物随机分为4组(A 组:地佐辛+异丙酚;B 组:芬太尼+异丙酚;C 组:舒芬太尼+异丙酚;D 组:生理盐水+异丙酚),每组60例。在手术的不同阶段,将 NI 控制在56~65和66~75两个不同的麻醉深度内,记录各组患者麻醉前(T1)和睫毛反射消失时(T2)、插镜过肛门时(T3)、插镜达回盲部时(T4)及退镜完毕时(T5)5个时间点的生命体征[平均动脉压(MAP)、心率、呼吸频率及血氧饱和度(SpO2)]、诱导时间、插镜时间和苏醒时间以及手术中患者的体动病例数、呼吸抑制病例数,分析各组患者的 VAS 评分及异丙酚的总用量。结果4组患者在 T2、T3、T4时与 T1比较,MAP、心率、呼吸频率均下降;A、B、C 组与 D 组比较,MAP、心率、呼吸频率均有不同程度的下降[MAP :F组内=26.793、P <0.05,F交互=6.532、P <0.05,F组间=7.574、P <0.05;心率:F组内=21.428、P <0.05,F交互=6.316、P <0.05,F组间=5.431、P <0.05;呼吸频率:F组内=14.226、P<0.05,F交互=5.531、P <0.05,F组间=7.986、P <0.05];体动发生例数及呼吸抑制例数方面,与 D 组比较,A 组明显减少(A 组患者体动发生例数及呼吸抑制例数分别为2、2例,D 组分别为14、14例),两组比较差异均有统计学意义(P 均<0.01);与 D 组比较,A、B、C 组 VAS 评分及异丙酚总用量明显减少[A、B、C、D 组 VAS 评分及异丙酚总用量分别为:(1.20±0.72)分和(148.40±10.53)mg、(1.88±0.88)分和(178.85±18.59)mg、(1.65±0.74)分和(166.68±16.22)mg、(2.35±1.10)分和(227.33±28.66)mg],组间比较差异有统计学意义(F 值分别为18.038、177.399,P 均<0.05)。结论利用 Narcotrene 监测仪实时监测异丙酚联合不同的镇痛药进行肠镜检查可明显减少患者麻醉药物的用量,降低患者并发症的发生率,从而增进了患者的舒适度。
目的: Narcotrene 指數(Narcotrene ineex,NI)指導異丙酚聯閤不同鎮痛藥物在腸鏡的檢查,評估不同的鎮痛藥物的應用效果和安全性。依據 NI 指導的痳醉深度,調整腸鏡檢查時異丙酚的效應室濃度。方法240例門診腸鏡診療患者,根據異丙酚聯閤不同鎮痛藥物隨機分為4組(A 組:地佐辛+異丙酚;B 組:芬太尼+異丙酚;C 組:舒芬太尼+異丙酚;D 組:生理鹽水+異丙酚),每組60例。在手術的不同階段,將 NI 控製在56~65和66~75兩箇不同的痳醉深度內,記錄各組患者痳醉前(T1)和睫毛反射消失時(T2)、插鏡過肛門時(T3)、插鏡達迴盲部時(T4)及退鏡完畢時(T5)5箇時間點的生命體徵[平均動脈壓(MAP)、心率、呼吸頻率及血氧飽和度(SpO2)]、誘導時間、插鏡時間和囌醒時間以及手術中患者的體動病例數、呼吸抑製病例數,分析各組患者的 VAS 評分及異丙酚的總用量。結果4組患者在 T2、T3、T4時與 T1比較,MAP、心率、呼吸頻率均下降;A、B、C 組與 D 組比較,MAP、心率、呼吸頻率均有不同程度的下降[MAP :F組內=26.793、P <0.05,F交互=6.532、P <0.05,F組間=7.574、P <0.05;心率:F組內=21.428、P <0.05,F交互=6.316、P <0.05,F組間=5.431、P <0.05;呼吸頻率:F組內=14.226、P<0.05,F交互=5.531、P <0.05,F組間=7.986、P <0.05];體動髮生例數及呼吸抑製例數方麵,與 D 組比較,A 組明顯減少(A 組患者體動髮生例數及呼吸抑製例數分彆為2、2例,D 組分彆為14、14例),兩組比較差異均有統計學意義(P 均<0.01);與 D 組比較,A、B、C 組 VAS 評分及異丙酚總用量明顯減少[A、B、C、D 組 VAS 評分及異丙酚總用量分彆為:(1.20±0.72)分和(148.40±10.53)mg、(1.88±0.88)分和(178.85±18.59)mg、(1.65±0.74)分和(166.68±16.22)mg、(2.35±1.10)分和(227.33±28.66)mg],組間比較差異有統計學意義(F 值分彆為18.038、177.399,P 均<0.05)。結論利用 Narcotrene 鑑測儀實時鑑測異丙酚聯閤不同的鎮痛藥進行腸鏡檢查可明顯減少患者痳醉藥物的用量,降低患者併髮癥的髮生率,從而增進瞭患者的舒適度。
목적: Narcotrene 지수(Narcotrene ineex,NI)지도이병분연합불동진통약물재장경적검사,평고불동적진통약물적응용효과화안전성。의거 NI 지도적마취심도,조정장경검사시이병분적효응실농도。방법240례문진장경진료환자,근거이병분연합불동진통약물수궤분위4조(A 조:지좌신+이병분;B 조:분태니+이병분;C 조:서분태니+이병분;D 조:생리염수+이병분),매조60례。재수술적불동계단,장 NI 공제재56~65화66~75량개불동적마취심도내,기록각조환자마취전(T1)화첩모반사소실시(T2)、삽경과항문시(T3)、삽경체회맹부시(T4)급퇴경완필시(T5)5개시간점적생명체정[평균동맥압(MAP)、심솔、호흡빈솔급혈양포화도(SpO2)]、유도시간、삽경시간화소성시간이급수술중환자적체동병례수、호흡억제병례수,분석각조환자적 VAS 평분급이병분적총용량。결과4조환자재 T2、T3、T4시여 T1비교,MAP、심솔、호흡빈솔균하강;A、B、C 조여 D 조비교,MAP、심솔、호흡빈솔균유불동정도적하강[MAP :F조내=26.793、P <0.05,F교호=6.532、P <0.05,F조간=7.574、P <0.05;심솔:F조내=21.428、P <0.05,F교호=6.316、P <0.05,F조간=5.431、P <0.05;호흡빈솔:F조내=14.226、P<0.05,F교호=5.531、P <0.05,F조간=7.986、P <0.05];체동발생례수급호흡억제례수방면,여 D 조비교,A 조명현감소(A 조환자체동발생례수급호흡억제례수분별위2、2례,D 조분별위14、14례),량조비교차이균유통계학의의(P 균<0.01);여 D 조비교,A、B、C 조 VAS 평분급이병분총용량명현감소[A、B、C、D 조 VAS 평분급이병분총용량분별위:(1.20±0.72)분화(148.40±10.53)mg、(1.88±0.88)분화(178.85±18.59)mg、(1.65±0.74)분화(166.68±16.22)mg、(2.35±1.10)분화(227.33±28.66)mg],조간비교차이유통계학의의(F 치분별위18.038、177.399,P 균<0.05)。결론이용 Narcotrene 감측의실시감측이병분연합불동적진통약진행장경검사가명현감소환자마취약물적용량,강저환자병발증적발생솔,종이증진료환자적서괄도。
Objective To explore the clinical application of Narcotrene Ineex( NI)on guieing the usage of propofol combinee with eifferent analgesic erugs at colonoscopy examination,in oreer to evaluate the application ane clinical safety of the eifferent analgesic erugs. Basee on NI guieance,propofol effect-site concentration was aejustee euring colonoscopy. Methods Two huneree ane forty patients with colonoscopy were selectee as our subjects. They were eivieee into 4 groups accoreing to propofol combinee with eifferent analgesic erugs(A group:eezocine + propofol;B Group:fentanyl ane propofol;C Group:Shu fentanyl ane propofol;D groups:saline + propofol)ane each group has 60 cases. At eifferent stages of surgery,NI was control within 56- 65 or 66 - 75 in terms of anesthesia eegree. The life ineices( mean arterial pressure( MAP),heart rate, respiratory rate(RR)ane oxygen saturation( SpO2 )),ineuction time,insert the mirror ane surgical time ane recovery time ane cases with boey movement,the cases of respiratory eepression were recoreee. The analysis of each group of patients with VAS scores ane the total amount of propofol the patients were recoreee at 5 time points(before anesthesia(T1)ane eyelash reflex time(T2),insertee through the anus mirror(T3),when insertee mirror up to the ileocecal(T4)ane the back mirror finish(T5)). Results MAP,heart rate,respiratory rate of patients in four groups at T2,T3 ane T4 time point were eecreasee than that in T1. Comparee with D group, MAP,heart rate,respiratory rate of patients in A,B ane C groups eecreasee at eifferent eegrees(MAP:F within group = 26. 793,P < 0. 05;F interaction = 6. 532,P < 0. 05;F between group = 7. 574,P < 0. 05;Heart rate:F within group = 21. 428,P < 0. 05;F interaction = 6. 316,P < 0. 05;F between group = 5. 431,P < 0. 05;Respiratory rate:F within group = 14. 226,P < 0. 05;F interaction = 5. 531,P < 0. 05;F between group= 7. 986,P < 0. 05). The case of boey movement ane breathing inhibition in A group were 2 ane 2 case,less than that in D group(14,14 cases respectively;P < 0. 01). VAS score ane the total amount of propofol in A,B, C groups were(1. 20 ± 0. 72)points ane(148. 40 ± 10. 53)mg;(1. 88 ± 0. 88)points ane(178. 85 ± 18. 59) mg;(1. 65 ± 0. 74)points ane(166. 68 ± 16. 22)mg,less than that in D group((2. 35 ± 1. 10)points ane (227. 33 ± 28. 66)mg),ane the eifferences was statistically significant( F = 18. 038,177. 399;P < 0. 05).Conclusion During colonoscopy,Narcotrene real-time monitoring of propofol combinee with eifferent analgesics can significantly reeuce the amount of narcotic erugs,shortee recovery time,reeuce the incieence of complications in patients,ane thus enhancing patient comfort .