靶控输注瑞芬太尼行无痛小肠镜检查09年会投稿3月26日.docVIP

靶控输注瑞芬太尼行无痛小肠镜检查 魏威 田鸣 中文摘要 目的 研究单纯靶控输注瑞芬太尼用于无痛小肠镜检查的可行性和安全性。 方法 将30位择期行小肠镜检查患者，ASA I-II级，随机分为两组（L组和H组），两组均无术前药。常规监护及BIS监测后进行血浆靶控输注瑞芬太尼，L组预设浓度为2.5 μg/L，H组预设浓度为3.5 μg/L，待效应室达到预设浓度时开始内镜操作。术中患者主诉疼痛难以忍受或出现严重体动影响手术时以1 μg/L为单位提高瑞芬太尼靶浓度，最高不超过6 μg/L。若SpO2低于90%则给予面罩加压给氧。在进镜前后和术中观察并记录无创平均动脉压、心率、SpO2、VAS评分、BIS值、并发症发生率（呼吸抑制、恶心、呕吐、咳嗽、躁动及肌僵）以及瑞芬太尼用药总量，并进行组间比较。 结果 L组与H组患者VAS平均分为别为7.1分和5.7分（P＞0.05），L组和H组平均BIS值分别为86±5和82±7 (P＞0.05)。两组患者进镜前后收缩压、心率无明显变化（P＞0.05），L组与H组辅助呼吸发生率为0/15和4/15（P=0.068＞0.05）。L组和H组术中体动的发生率分别为6/15和2/15(P=0.098＞0.05)。瑞芬太尼总用药量分别为825.1±42.1 μg和1165.5±47.6 μg (P＜0.01）。 结论 瑞芬太尼靶浓度约为3 μg/L时可为小肠镜检查提供适合的镇痛强度，同时应注意呼吸及气道管理。 关键词 瑞芬太尼，靶控输注，监测麻醉，小肠镜。 Target controlled infusion of remifentanil in patients undergoing enteroscopy abstract Objective To estimate the feasibility and security of monitored anethesia using target controlled infusion of remifentanil in patients undergoing enteroscopy . Methods Thirty patients(ASA Ⅰ-Ⅱ grade), scheduled for enteroscopy, were randomly allocated into two groups. All the patients were administered by plasma target controlled infusion of remifentanil. The target concentrations were 2.5 μg/L in group L（n=15）and 3.5 μg/L in group H（n=15）respectively. Operations began as soon as the effect-site concentration came up to the preconcerted value. Bispectral Index (BIS) was applied in both groups. When patients’ movement appeared that disturbed the operation, higher level of remifentanil could be administered. Oxygen should be given by mask routinely and to make breath manually when pulse oxygen saturation (SpO2) 90%. Mean blood pressure, heart rate, SpO2 and BIS value were monitored. Other parameters included visual analgesia score(VAS), complications, dosage and frequency of remifentanil injection. Results BIS value of the two groups were 86±5 and 82±7 respectively，and the average VAS were 7.1 and 5.7 respectively, which were in well analgesia and were not statistically different between them. The incidence of manually breath were