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| 丙泊酚复合纳布啡对无痛肠镜检查患者膈肌运动的影响 |
| Effects of propofol combined with nalbuphine on the diaphragmatic movement of patients with colonoscopy |
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| DOI：10.12089/jca.2019.01.010 |
| 中文关键词: 超声 丙泊酚 纳布啡 膈肌运动幅度 膈肌厚度 |
| 英文关键词: Ultrasound Propofol Nalbuphine Diaphragmatic movement range Diaphragmatic thickness |
| 基金项目:南京市科技发展计划项目（201715033）;南京市医学科技发展资金资助（QRX17019） |
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| 中文摘要: |
目的 探讨超声监测下丙泊酚复合纳布啡对肠镜检查患者膈肌运动的影响。
方法 选择择期行无痛肠镜检查患者40例，男21例，女19例，年龄18～65岁，BMI 18～25 kg/m2，ASA Ⅰ或Ⅱ级，采用随机数字表法将患者均分为两组（n=20）∶丙泊酚组（P组）和丙泊酚复合纳布啡组（F组）。F组患者在丙泊酚输注前1 min静脉推注纳布啡0.1 mg/kg，P组给予等容量的生理盐水。两组患者TCI模式给予丙泊酚，初始血浆靶浓度为2 μg/ml，逐渐调整靶浓度，直至Ramsay镇静评分为5分，开始肠镜检查。肠镜检查中根据Ramsay评分调整丙泊酚靶浓度。超声监测患者右侧膈肌运动情况。记录患者入室平静呼吸时（T0）、丙泊酚输注后Ramsay评分5分时（T1）以及肠镜检查结束后Ramsay评分2分时（T2）的SpO2、MAP、HR、PETCO2、RR、膈肌运动幅度（DM）、吸气末膈肌厚度(TEI)、呼气末膈肌厚度(TEE)，计算膈肌厚度变化率（DTF）=(TEI-TEE)/TEI。记录心动过缓、低血压、体动、呼吸抑制等不良反应。
结果 与T0时比较，两组T1时MAP和SpO2明显降低，HR和RR明显减慢，PETCO2明显升高（P < 0.05）；P组丙泊酚用量明显多于F组（P < 0.05）；T1、T2时F组DM明显长于，T1时DTF明显高于P组（P < 0.05）。P组2例发生体动反应，F组1例出现窦性心动过缓。两组均未发生低血压、呼吸抑制和反流误吸等不良反应。
结论 与单用丙泊酚比较，丙泊酚复合纳布啡一定程度上可以减轻对无痛肠镜检查患者膈肌运动的抑制程度。 |
| 英文摘要: |
Ojective To investigate the effects of propofol combined with nalbuphine on diaphragmatic movement monitored by ultrasound in patients undergoing colonoscopy.
Methods Forty patients, males 21 and females 19, aged 18-65 years, BMI 18 - 25 kg/m2, ASA physical status I or II, were recruited and scheduled to undergo elective painless colonoscopy. All patients were randomly divided into two groups (n = 20): propofol group (group P) and propofol combined with nalbuphine group (group F). Patients in group F received nalbuphine 0.1mg/kg intravenously 1 min before propofol administration, and patients in group P received same volume of normal saline. Propofol was infused by TCI and the initial target plasma concentration was set at 2 μg/ml in all patients. The target concentration was adjusted gradually until the Ramsay sedation score reached 5. Then colonoscopy was started. During the colonoscopy, the propofol concentration was adjusted according to the Ramsay score. Ultrasound was used to monitor the movement of the right diaphragm of the patients. SpO2, MAP, HR, PETCO2, RR, diaphragmatic movement (DM), diaphragmatic thickness at the end of inspiration (TEI) and diaphragmatic thickness at the end of expiration (TEE) were recorded under calm breathing after entering the room (T0), Ramsay sedation score 5 points after propofol administration (T1), and Ramsay sedation score 2 after endoscopy (T2) . The diaphragmatic thickening fraction (DTF) was calculated: DTF= (TEI-TEE) /TEI. Adverse reactions such as bradycardia, hypotension, body movement, and respiratory depression were recorded.
Results Compared with T0, MAP, SpO2, HR and RR decreased, and PETCO2 increased at T1 time point in patients of the two groups (P < 0.05). Compared with group F, the dose of propofol increased in group P (P < 0.05). DM at T1 and T2, DTF at T1 were obviously higher in group F than those in group P (P < 0.05). There were two cases had body movement in group P, and one case had bradycardia in group F. There was no case suffered from hypotension, respiratory depression and reflux aspiration in two groups.
Conclusion Compared with propofol alone, propofol combined with nalbuphine can attenuate the dysfunction of the diaphragm. |
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