靶控输注在老年患者无痛结肠镜检查和治疗中的应用观察

摘要

Objective To discuss the clinical application effect of target controlled infusion (TCI) in elderly patients un-dergoing painless colonoscopy. Methods 80 elderly patients undergoing painless colonoscopic examination and treatment in our hospital from May to September 2014 were selected and randomly divided into the TCI group (group T)and the manual infusion group(group M),40 cases in each group. The anesthesia in the group T:fentanyl 0.03-0.05 mg by intravenous injection and propofol plasma target concentration was set at 3μg/mL;which in the group M:fentanyl 0.03-0.05 mg and propofol 1.0-1.5 mg/kg by in-travenous injection in turn. The colonoscopic examination and treatment were started after the patients in both two groups fell asleep and eyelash reflex disappeared. The changes of SBP,DBP,HR,RR and SpO2 before medication,at 2 min after medication, immediately colonoscopy,at 5,8,10 min after colonoscopy were recorded;the consciousness disappearance time,awakening time,leaving hospital time,adverse reactions and propofol dosage were recorded too. Results HR and SpO2 at 2 min after medi-cation had statistical differences between the two groups (P<0.05);DBP and HR at 5 min after colonoscopy showed statistical dif-ferences between the two groups(P<0.05);the propofol dosage,intraoperative additional dose,drug effect onset time,patient′s awaken-ing time and leaving hospital time had statistical differences between the two groups (P<0.05). Conclusion TCI anesthesia is more smooth and steady,has slight hemodynamic change,short awakening time,mild respiratory depression,unobvious injection pain and few adverse reactions,and should become the mainstream clinical medication mode.%目的：探讨靶控输注（TCI）在老年患者无痛结肠镜检查中的临床应用效果。方法选取2014年5～9月在该院行结肠镜检查和治疗的老年患者80例，按抽签法随机分为靶控组（T组）和人工推注组（M组），各40例；T组麻醉：静脉注射芬太尼0.03～0.05 mg，设定丙泊酚血浆靶浓度为3μg/mL；M组麻醉：依次静脉注射芬太尼0.03～0.05 mg、丙泊酚1.0～1.5 mg/kg。待两组患者入睡，睫毛反射消失后开始结肠镜检查和治疗。记录两组患者给药前，给药后2 min，镜检即刻，镜检后5、8、10 min时收缩压（SBP）、舒张压（DBP）、心率（HR）、呼吸频率（RR）、脉搏血氧饱和度（SpO2）变化；记录意识消失和苏醒时间、离院时间和不良反应及丙泊酚用量。结果两组患者给药后2 min时HR和SpO2比较，差异均有统计学意义（P<0.05）；两组患者镜检后5 min时DBP和HR比较，差异均有统计学意义（P<0.05）；两组患者丙泊酚用量、术中追加剂量、药物起效时间、患者苏醒时间及离院时间比较，差异均有统计学意义（P<0.05）。结论 TCI麻醉更加平稳，血流动力学变化轻微，苏醒时间短，呼吸抑制轻，注射痛不明显，不良反应少，应成为临床用药方式的主流。