盐酸羟考酮注射液联合丙泊酚闭环靶控输注在老年患者无痛肠镜中的应用*

吕建瑞田俊斌薛荣亮张珍妮王宁

(西安交通大学第二附属医院麻醉科， 陕西 西安 710004)

【摘要】目的探讨盐酸羟考酮注射液联合丙泊酚闭环靶控输注在老年患者无痛肠镜中的应用价值。方法拟行无痛肠镜检查患者60例，ASAⅠ～Ⅱ，年龄65～81岁，男28例，女32例，按随机数字表法分为两组：盐酸羟考酮组(Q组)和芬太尼组(F组)，每组30例。Q组先静注盐酸羟考酮0.1mg/kg，F组静注芬太尼1ug/ kg，5min后开始闭环靶控输注丙泊酚。记录并比较两组术中HR、MAP、SpO2、BIS值的变化、肠镜检查时间、苏醒时间、术中丙泊酚的用量、苏醒后VAS评分以及围术期不良反应的发生。结果两组患者在麻醉后均MAP降低(P<0.05)，HR减慢(P<0.05)，BIS值降低(P<0.05)，但组间比较无显著性差异(P>0.05)。F组SpO2在麻醉后明显降低(P<0.05)，且明显低于Q组(P<0.05)。Q组术中丙泊酚用量、苏醒时间、苏醒后VAS评分以及术中呼吸抑制的发生率均明显低于F组(P<0.05)。结论盐酸羟考酮注射液联合丙泊酚闭环靶控输注应用于老年患者无痛肠镜麻醉，可明显减少丙泊酚用量，缩短苏醒时间，更好地维持术中呼吸和循环功能平稳，使患者术后更为舒适，是一种安全有效的无痛肠镜麻醉方法。

【关键词】羟考酮； 二异丙酚； 闭环靶控输注； 老年； 无痛肠镜

【中图分类号】R 614.2

【文献标志码】A

doi：10.3969/j.issn.1672-3511.2015.10.011

Abstract【】ObjectiveTo explore application of oxycodone hydrochloride injection combined with closed-loop target controlled infusion of propofol in elderly patients undergoing painless colonoscopy. MethodsSixty elderly patients with ASAⅠ～Ⅱ,aged 65～81 yr, undergoing painless colonoscopy, were randomly divided into oxycodone group (group Q) and fentanyl group (group F). Oxycodone hydrochloride injection was given with 0.1mg/kg in group Q while fentanyl was given with 1ug/ kg in group F 5 min before closed-loop target controlled infusion of propofol. HR, MAP, SpO2, Bis index, enteroscopy time, revival time, the dosage of propofol, visual analogue scale(VAS) and adverse reaction were recorded and compared between two groups. ResultsMAP, HR and Bis index were all lower after anesthesia in both groups (P<0.05) but there was no statistical difference between the two groups. SpO2 in group F was lower after anesthesia(P<0.05) and was lower than that in group Q(P<0.05). The dosage of propofol, revival time, VAS and the incidence of respiratory depression in group Q were all lower than that in group F(P<0.05). ConclusionThe application of oxycodone hydrochloride injection combined with closed-loop target controlled infusion of propofol in elderly patients undergoing painless colonoscopy could decrease the dose of propofol, shorten revival time, enable intraoperative respiratory and circulatory function more steady and make patients more comfortable after operation.

基金项目：国家临床重点专科建设项目(2011873)

通讯作者：薛荣亮，Email: xuerl299@163.com

收稿日期：( 2015-08-03； 编辑： 陈舟贵)

Application of oxycodone hydrochloride injection combined with closed-loop target controlled infusion of propofol in elderly patients undergoing painless colonoscopyLV Jianrui,TIAN Junbin,XUE Rongliang,etal

(DepartmentofAnesthesiology,TheSecondAffiliatedHospitalofXi’anJiaotongUniversity,Xi’an710004,China)

【Key words】Oxycodone; Propofol; Closed-loop target controlled infusion; Elderly patients; Painless colonoscopy.

肠镜检查由于对肠道的充气和牵拉刺激，常给患者造成不适和痛苦，无痛肠镜虽然可提高患者的舒适度和耐受性，但在麻醉过程中，也存在着呼吸抑制、循环波动等风险，特别是老年患者，由于重要脏器功能减退，合并症多，更易诱发心血管风险[1]。因此，合理的麻醉方案以及麻醉药物的选择就成为关键。本研究拟探讨盐酸羟考酮注射液联合丙泊酚闭环靶控输注在老年患者无痛肠镜中的应用，为临床麻醉选择提供参考。

1资料与方法

1.1病例选择与分组受试对象为2014年2月～2015年2月到我院消化内科拟行无痛肠镜检查患者，共60例，ASAⅠ～Ⅱ，年龄65～81岁，男28例，女32例，所有患者术前无严重心肺肝肾疾病及意识异常。……