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目的比较丙泊酚复合不同阿片类药物在无痛胃镜检查中的应用效果。方法拟行无痛胃镜检查的患者120例,ASAⅠ～Ⅱ级,年龄25～60岁,体重45～75kg。随机分为3组,芬太尼组(F组)、舒芬太尼组(S组)、瑞芬太尼组(R组)每组40例。F组静脉注射芬太尼0.8μg/kg,S组静脉注射舒芬太尼0.08μg/kg,R组静脉注射瑞芬太尼0.5μg/kg,各组均静脉注射丙泊酚1～2mg/kg,意识消失时置入胃镜,术中酌情追加丙泊酚0.5～1mg/kg,观察3组患者丙泊酚用量、苏醒时间、视觉模拟评分(VAS),评价清醒时和1h后疼痛程度及不良反应的发生情况。结果与F组和S组比较,R组丙泊酚用量最少,分别为(120±14)mg、(118±18)mg及(96±15)mg(P<0.05);而R组低氧血症发生率显著增加(5%、5%vs.16%,P<0.05);与F组和R组比较,S组清醒1h后VAS评分减低,分别为5.0±0.9、5.1±0.8、4.0±1.1(P<0.05)。结论在无痛胃镜检查中0.5μg/kg瑞芬太尼组较0.8μg/kg芬太尼组和0.08μg/kg舒芬太尼组丙泊酚用量减少,但是对呼吸的抑制较舒芬太尼组和芬太尼组重。舒芬太尼组术后舒适程度优于芬太尼组及瑞芬太尼组。
Objective To compare the effects of different opioid propofol compounds in painless gastroscopy. Methods 120 patients with painless gastroscopy were enrolled in this study. ASA Ⅰ ~ Ⅱ grade patients aged 25-60 years old and weighing 45-75kg. The patients were randomly divided into three groups: 40 in each group, fentanyl (group F), sufentanil (group S) and remifentanil (group R). Group F received intravenous fentanyl 0.8 μg / kg, Group S received intravenous injection of sufentanil 0.08 μg / kg, Group R received remifentanil 0.5 μg / kg intravenously with propofol 1-2 mg / kg. Consciousness disappeared when gastroscope was placed. Intraoperative propofol was added 0.5 ~ 1mg / kg as appropriate. The propofol dosage, recovery time and visual analogue scale (VAS) were observed in 3 groups. The pain degree after awake and 1h Adverse reactions occurred. Results Compared with group F and group S, the dosage of propofol was the lowest in group R (120 ± 14) mg, (118 ± 18) mg and (96 ± 15) mg, respectively (P <0.05) The incidence of sepsis was significantly increased (5% vs 5% vs.16%, P <0.05). Compared with F group and R group, the VAS score of S group decreased significantly after 1 hour of awake, which were 5.0 ± 0.9,5.1 ± 0.8,4.0 ± 1.1 (P <0.05). Conclusions In painless gastroscopy, the dosage of propofol in 0.5μg / kg remifentanil group was lower than that in 0.8μg / kg fentanyl group and 0.08μg / kg sufentanil group, but the inhibition of respiration was less than that of sufentanil Nepalese group and fentanyl group weight. Sufentanil group postoperative comfort was better than fentanyl group and remifentanil group.