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| 阿芬太尼复合丙泊酚对结肠镜检查患者术后恢复质量的影响 |
| Effects of alfentanil combined with propofol on postoperative recovery quality in patients undergoing colonoscopy |
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| DOI：10.12089/jca.2021.11.006 |
| 中文关键词: 阿芬太尼 瑞芬太尼 丙泊酚 结肠镜检查 恢复期质量 |
| 英文关键词: Alfentanil Remifentanil Propofol Colonoscopy Recovery quality |
| 基金项目:南京市医学科技发展资金资助（QRX17019，YKK18105）；江苏省六大人才高峰项目（WSW-106） |
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| 摘要点击次数: 1976 |
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| 中文摘要: |
目的 探讨阿芬太尼或瑞芬太尼复合丙泊酚对结肠镜检查患者术后恢复质量的影响。
方法 选择2020年8—10月择期门诊行无痛结肠镜检查的患者205例，男104例，女101例，年龄18～65岁，BMI 18～25 kg/m 2，ASA Ⅰ或Ⅱ级。采用随机数字表法分为三组：阿芬太尼组（A组，n=68）、瑞芬太尼组（R组，n=71）和丙泊酚组（P组，n=66）。术前A组静脉推注阿芬太尼10 μg/kg加生理盐水稀释至20 ml，R组静脉推注瑞芬太尼0.5 μg/kg加生理盐水稀释至20 ml，P组给予生理盐水20 ml。随后三组患者静脉泵注丙泊酚2 mg·kg-1·min-1至BIS为65时行结肠镜检查。采用术后恢复质量量表（PQRS）记录检查结束后15 min、离院时、检查结束后1、3 d的生理功能、伤害性反应、情绪、日常生活活动能力和认知功能的恢复情况。记录心血管活性药物使用例数和低氧、低血压、心动过缓、咳嗽反射和体动反应等不良反应发生情况。
结果 与P组比较，A组和R组离院时生理功能恢复率明显升高（P＜0.05）；检查结束后15 min和离院时日常生活活动能力恢复率明显升高（P＜0.05），检查结束后1、3 d认知功能恢复率明显升高（P＜0.05），心血管活性药物使用率明显降低（P＜0.05），低氧、低血压和体动反应发生率明显降低（P＜0.05）；A组检查结束后15 min、离院时、检查结束后1 d伤害性反应恢复率明显升高（P＜0.05），离院时认知功能恢复率明显升高（P＜0.05）；R组检查后15 min、离院时伤害性反应恢复率明显升高（P＜0.05），咳嗽反射发生率明显升高（P＜0.05）。与R组比较，A组检查结束后15 min、离院时、检查结束后1 d伤害性反应恢复率明显升高（P＜0.05），低氧、低血压、心动过缓和咳嗽反射发生率明显降低（P＜0.05）。
结论 阿芬太尼或瑞芬太尼复合丙泊酚应用于结肠镜检查，患者术后恢复质量优于单纯应用丙泊酚。阿芬太尼的伤害性反应恢复率高于瑞芬太尼，低氧、低血压和咳嗽反射发生率低于瑞芬太尼，安全性更高。 |
| 英文摘要: |
Objective To investigate the effect of alfentanil or remifentanil combined with propofol on postoperative recovery quality of patients undergoing colonoscopy.
Methods A total of 205 patients undergoing colonoscopy, 104 males and 101 females, aged 18-65 years, BMI 18-25 kg/m2, ASA physical status Ⅰ or Ⅱ, were randomly divided into 3 groups: alfentanil group (group A, n = 68), remifentanil group (group R, n = 71) and propofol group (group P, n = 66). Patients in group A received alfentanil 10 μg/kg (diluted in 20 ml normal saline), patients in group R received remifentanil 0.5 μg/kg (diluted in 20 ml normal saline) and patients in group P received normal saline via intravenous injection. Subsequently, all patients were intravenously administrated propofol at 2.0 mg·kg-1·min-1 until the bispectral index (BIS) fell 65 below before performing colonoscopy. The recovery rate of physiology, nociception, emotion, activity-of-daily-living and cognition was recorded 15 minutes after colonoscopy, at discharge, 1 day, and 3 days according to the postoperative quality recovery scale (PQRS). The cases of using cardiovascular drugs and the incidence of adverse reactions including hypoxia, hypotension, bradycardia, cough reflex and body movement were recorded.
Results Compared with group P, the recovery rate of physiology when discharge, recovery rate of nociception and activity-of-daily-living 15 minutes after colonoscopy and at discharge were significantly increased in groups A and R (P < 0.05), the recovery rate of cognition increased 1 day and 3 days after colonoscopy in groups A and R (P < 0.05), the rate of using cardiovascular active drugs was significantly reduced (P < 0.05), the incidence of hypoxia, hypotension and body movement reaction were significantly reduced in groups A and R (P < 0.05), the recovery rate of nociception was significantly increased 15 minutes after colonoscopy, at discharge, and 1 day after colonoscopy in group A (P < 0.05), the recovery rate of cognition was significantly increased at discharge in group A (P < 0.05), the recovery rate of nociception was significantly increased 15 minutes after colonoscopy and at discharge in group R (P < 0.05), the recovery rate of cognition was significantly increased at discharge in group A (P < 0.05), and the incidence of cough reflex was significantly increased in group R (P < 0.05). Compared with group R, the recovery rate of nociception was significantly increased 15 minutes after colonoscopy, at discharge, and 1 day after colonoscopy in group A (P < 0.05), the incidence of hypoxia, hypotension, bradycardia and cough reflex were significantly reduced in group A (P < 0.05).
Conclusion The postoperative recovery quality of patients receiving alfentanil or remifentanil combined with propofol during colonoscopy is better than propofol. Patients given alfentanil have higher recovery rate of nociceptive response, and lower incidence of cough reflex than that of remifentanil. |
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