CAJ | 학술논문

目的：观察心动过缓患者无痛肠镜检查中山莨菪碱逆转瑞芬太尼不良反应的效果。方法选择该院门诊无痛肠镜检查的患者65例，分为3组：对照组（C组）21例、小壶滴注山莨菪碱组（A1组）22例和持续泵入山莨菪碱组（A2组）22例。诱导药均为静脉注射依托咪酯0．08mg／kg，异丙酚1．00mg／kg，瑞芬太尼0．10μg／kg；A1组诱导前滴注山莨菪碱10mg，A2组诱导前滴注山莨菪碱5mg，然后以0．25mg／min速度泵入；3组进镜后改为异丙酚4mg·kg‐1·h‐1、瑞芬太尼0．05μg·kg‐1·min‐1。镜至回盲部，停异丙酚；抽气退镜至降结肠时停瑞芬太尼。分别于诱导前（T0）、进镜前（T1）、镜至横结肠（T2）、镜至回盲部（T3）、镜出肛门（T4）观察并记录患者心率（HR）、血氧饱和度（SpO2）及平均动脉压（MAP），记录用药量、补液量、诱导时间、检查时间、苏醒时间、肠痉挛程度及例数和其他不良反应。结果诱导时间3组没有差别，检查时间和苏醒时间A1组和A2组均明显短于C组。在刺激较强的T2、T3时点A1组和A2组患者HR均较C组平稳，T1、T2时A2组HR波动均小于A1组。A1组和A2组相对于C组异丙酚、瑞芬太尼用量少、检查时间缩短、肠痉挛减少（P＜0．05）。A2组体动例数（1／22）与C组（4／21）之间有差异统计学意义（P＜0．05）。A1、A2组与C组之间差异有统计学意义（P＜0．05）。结论山莨菪碱10mg在无痛肠镜中两种方式均能有效逆转心动过缓同时应用瑞芬太尼患者HR减慢，持续泵入对HR影响波动更平稳。
목적：관찰심동과완환자무통장경검사중산랑탕감역전서분태니불량반응적효과。방법선택해원문진무통장경검사적환자65례，분위3조：대조조（C조）21례、소호적주산랑탕감조（A1조）22례화지속빙입산랑탕감조（A2조）22례。유도약균위정맥주사의탁미지0．08mg／kg，이병분1．00mg／kg，서분태니0．10μg／kg；A1조유도전적주산랑탕감10mg，A2조유도전적주산랑탕감5mg，연후이0．25mg／min속도빙입；3조진경후개위이병분4mg·kg‐1·h‐1、서분태니0．05μg·kg‐1·min‐1。경지회맹부，정이병분；추기퇴경지강결장시정서분태니。분별우유도전（T0）、진경전（T1）、경지횡결장（T2）、경지회맹부（T3）、경출항문（T4）관찰병기록환자심솔（HR）、혈양포화도（SpO2）급평균동맥압（MAP），기록용약량、보액량、유도시간、검사시간、소성시간、장경련정도급례수화기타불량반응。결과유도시간3조몰유차별，검사시간화소성시간A1조화A2조균명현단우C조。재자격교강적T2、T3시점A1조화A2조환자HR균교C조평은，T1、T2시A2조HR파동균소우A1조。A1조화A2조상대우C조이병분、서분태니용량소、검사시간축단、장경련감소（P＜0．05）。A2조체동례수（1／22）여C조（4／21）지간유차이통계학의의（P＜0．05）。A1、A2조여C조지간차이유통계학의의（P＜0．05）。결론산랑탕감10mg재무통장경중량충방식균능유효역전심동과완동시응용서분태니환자HR감만，지속빙입대HR영향파동경평은。
Objective To observe reverse effect of anisodamine to the adverse effect of remifentanil during enteroscopy without pain for patients with bradycardia .Methods Sixty‐five patients with bradycardia were selected and divided randomly into group C (n=21 ,control group)、group A1 (n=22 ,anisodamine by instillation) and group A2 (n=22 ,anisodamine by continous infusion) .In‐duction :Intravenous etomidate 0 .08 mg/kg ,propofol 1 .00 mg/kg and remifentanil 0 .10μg/kg in 3 groups .Ten mg anisodamine in‐fused by instillation before induction in group A1 ,5 mg anisodamine infused by instillation before induction and continous infused by 0 .25 mg/min in group A2 .Maintenance:All group received propofol 4 mg · kg‐1 · h‐1 ,remifentanil 0 .05 μg · kg‐1 · min‐1 after un‐dergoing enteroscopy .stopping pumping propofol when colonoscopy reached ileocecal junction ,and we took off remifentanil when colonoscopy withdraw to decending colon .Then we observed and recorded HR ,SpO2 ,MAP ,dosage ,fluid infusion ,induction time , check time ,analepsia time ,degree and of enterospasm and numbers of cases and side effect at T0 (before induction) ,T1 (beginning of operation) ,T2 (into the transverse colon) ,T3 (to the ileocecal junction) ,T4 (exit) .Results There were no significant difference a‐mong 3 groups of induction time .Compared with group A1 and group A2 about check time and analepsia time ,group C was much shorter .The HR of group A1 and A2 were more stable than group C at T2 、T3 .At T1 、T2 ,the fluctuation of HR of group A2 was less than that of group A1 .There was obviously different among 3 groups of propofol′s dosage ,operation time and enterospasm ,the effect of group A1 and group A2 were better .There was statistically significant in number of cases of body movement between group A1 (1/22)and group C(4/21) ,there was also statistical significance between group A1 ,group A2 and group C(P<0 .05) .Conclusion There are no difference between 2 methods about relieving enterospasm ,refraining intestinal angina ,shortening operation time , saving anesthetic dosage .Effect of continous pumping to undulation of HR may be more stable .