CAJ | 학술논문

目的：观察喷他佐辛复合靶控丙泊酚在无痛胃镜检查术中的应用效果和安全性。方法选取择期行无痛胃镜检查术的美国麻醉医师协会（ASA）分级为Ⅰ～Ⅲ级的老年患者90例，随机分为对照组（C组）、喷他佐辛Ⅰ组（P1组）和喷他佐辛Ⅱ组（P2组），各30例。C组开始采用效应室靶浓度2～3 mg/L靶控输注( TCI )丙泊酚，逐渐增至4～5 mg/L，当改良清醒镇静评分（MOAA/S评分）为0分时减至2～3 mg/L；P1组和P2组分别在TCI丙泊酚前3 min静脉注射喷他佐辛0.2 mg/kg和0.4 mg/kg。记录麻醉前（T1）、MOAA/S评分为0时( T2)、插镜过咽喉时（T3）、检查结束时( T4)和苏醒时（T5）的收缩压（SBP）、舒张压（DBP）、心率（HR）和指脉搏血氧饱和度（SpO2）的变化；记录诱导时间、胃镜操作时间、清醒时间、离院时间和丙泊酚总用量；观察并记录体动、呛咳、恶心呕吐、嗝逆等不良反应。结果 P2组SBP，DBP和HR在T2时与C组和P1组比较，差异有显著性（ P﹤0.05）；P2组的诱导时间、清醒时间、离院时间和丙泊酚的总用量均显著少于C组( P﹤0.05)；P2组的体动和恶心呕吐发生率明显低于C组( P﹤0.05)；P1组和P2组的低氧血症发生率显著低于C组( P﹤0.05)；P2组的低血压发生率明显低于C组( P﹤0.05)。结论喷他佐辛0.4 mg/kg复合TCI丙泊酚用于老年人无痛胃镜检查术不良反应最少，更安全，更适合无痛胃镜检查术。
목적：관찰분타좌신복합파공병박분재무통위경검사술중적응용효과화안전성。방법선취택기행무통위경검사술적미국마취의사협회（ASA）분급위Ⅰ～Ⅲ급적노년환자90례，수궤분위대조조（C조）、분타좌신Ⅰ조（P1조）화분타좌신Ⅱ조（P2조），각30례。C조개시채용효응실파농도2～3 mg/L파공수주( TCI )병박분，축점증지4～5 mg/L，당개량청성진정평분（MOAA/S평분）위0분시감지2～3 mg/L；P1조화P2조분별재TCI병박분전3 min정맥주사분타좌신0.2 mg/kg화0.4 mg/kg。기록마취전（T1）、MOAA/S평분위0시( T2)、삽경과인후시（T3）、검사결속시( T4)화소성시（T5）적수축압（SBP）、서장압（DBP）、심솔（HR）화지맥박혈양포화도（SpO2）적변화；기록유도시간、위경조작시간、청성시간、리원시간화병박분총용량；관찰병기록체동、창해、악심구토、격역등불량반응。결과 P2조SBP，DBP화HR재T2시여C조화P1조비교，차이유현저성（ P﹤0.05）；P2조적유도시간、청성시간、리원시간화병박분적총용량균현저소우C조( P﹤0.05)；P2조적체동화악심구토발생솔명현저우C조( P﹤0.05)；P1조화P2조적저양혈증발생솔현저저우C조( P﹤0.05)；P2조적저혈압발생솔명현저우C조( P﹤0.05)。결론분타좌신0.4 mg/kg복합TCI병박분용우노년인무통위경검사술불량반응최소，경안전，경괄합무통위경검사술。
Objective To investigate the application effect and safety of pentazocine combined with target-controlled infusion ( TCI ) of propofol for painless gastroscopy in senile patients. Methods 90 ASAⅠ~Ⅲ senile patients undergoing painless gastroscopy were ran-domly divided into the three groups:control group ( group C ) , pentazocine 1 group ( P1 ) and pentazocine 2 group ( P2 ) , 30 cases in each group. The group C was given the target effect-site concentration of TCI propofol 2-3 mg/L, which was gradually increased to 4-5 mg/L, when the modified obsevers assessment of alertness/sedation scale ( MOAA/S ) score was 0, which was decreased to 2-3 mg/L; the group P1 and P2 were intravenously injected by pentazocine 0. 2 mg/kg and 0. 4 mg/g at 3 min before TCI propofol respectively. SBP, DBP, HR, SpO2 at the time points of before anesthesia ( T1 ) , MOAA/S score was 0 ( T2 ) , gastroscope passing through pharynx and larynx ( T3 ) , end of the examination ( T4 ) and time for recovery ( T5 ) were recorded. The adverse reactions of body motion, bucking, nausea and vomiting and hiccup were observed and recorded. The induction time, gastroscope operating time, recovery time, time for leaving hospital and propofol total dosage were recorded. Results SBP, DBP and HR at T2 in the group P2 had statistically significantly differences compared with the group C and P1 ( P﹤0. 05 ) . The induction time, recovery time, time for leaving hospital and propofol total dosage in the group P2 were significantly less than those in the group C ( P﹤0. 05 ) . The occurrence rate of body motion, nausea and vomiting in the group P2 was significantly lower than that in the group C ( P﹤0. 05 ) . The occurrence rate of hypoxemia in the group P1 and P2 was significantly lower than that in the control group ( P﹤0. 05 ) . The occurrence rate of hypotension in the group P2 was significantly lower than that in the group C ( P﹤0. 05 ) . Conclusion Pentazocine 0. 4mg/kg combined with TCI propofol in senile painless gas-troscopy has least adverse reaction, more safety and is more suitable for painless gastroscopy.