Objective To investigate clinical application and safety evaluation of sedative demulcent anesthesia in therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods Totally 1660 patients underwent ERCP at the First Hospital of Lanzhou University were prospectively divided into two groups: venous sedative demulcent group (n=800, using sufentanil and midazolam and propofol continuing infusion) and conventional sedative demulcent group (n=860, using common medicine). The heart rate (HR), respiration (R), blood pressure (BP) and peripheral oxygen saturation (SpO2) of pre-anesthesia, post-anesthesia, during operation and after analepsia in every group were detected. The narcotism was evaluated by Ramsaymin grading method and the related adverse reactions such as cough, restlessness, harmful memory, and abdominal pain after operation were recorded. Results Compared with conventional sedative demulcent group, vital signs of patients in venous sedative demulcent group were more stable. For postoperative adverse reactions, abdominal pain, abdominal distension and nausea and vomiting were respectively 4.4%(35/800), 2.6%(21/800) and 3.6%(29/800) in venous sedative demulcent group, which were respectively higher of the incidence of 36.3%(312/860), 49.0%(421/860) and 53.0%(456/860) in conventional sedative demulcent group (P＜0.01). The postoperative satisfaction and adverse reactions recall between venous sedative demulcent group and conventional sedative demulcent group was respectively significant different (96.9% vs. 2.9%, 4.8% vs. 97.9%, P＜0.01). Conclusion Sufentanil and midazolam and propofol continuing infusion have good effect of sedative demulcent anesthesia, which can be widely used.
Objective To assess the correlation between bispectral index (BIS) and richmond agitation sedation scale (RASS) and sedation-agitation scale (SAS) through the spearman correlation coefficient by systematic review. Methods Databases including PubMed, EMbase, Web of Science, The Cochrane Library (Issue 7, 2016), CNKI, VIP, WanFang Data and CBM were searched from inception to July 2016 to collect literature on the correlation between BIS and RASS and SAS. The studies were screened according to the inclusion and exclusion criteria. After extracting data and assessing the quality of the included studies, meta-analysis was conducted using Comprehensive Meta Analysis 3.0 software. Results A total of 12 studies involving 397 patients were included. BIS was positively correlated with RASS score and SAS, and the summary correlation coefficient was 0.742 with 95% CI 0.678 to 0.795 and 0.605 with 95% CI 0.517 to 0.681, respectively. Conclusion BIS has a good correlation with RASS and SAS, which will provide more options for assessing sedation of patients with mechanical ventilation in ICU.
ObjectiveTo know the fundamental status of painless digestive endoscopy in China. MethodsA 23-item survey including multiple choices and fill-in-the-blank questions on 3 pages was performed on anesthesiologists in China excluding Taiwan, Macao and Hong Kong on www.xqnmz.com and www.dxy.cn/bbs from November 1 to December 31, 2013, among which 5 questions were on personal details, 9 on hospital and department, and 9 on clinic details. The results about the basic facts, risk factors of anesthesia and drug use and monitoring of painless digestive endoscopy in China were analyzed. ResultsA total of 726 questionnaires were collected, among which 667 (91.87%) were considered valid. Interviewed hospitals included hospitals from 31 provinces, municipalities and autonomous regions excluding Taiwan, Macao and Hong Kong. Thirty questionnaires were from the first-grade hospitals (4.5%), 292 from the second-grade (43.78%), and 345 from the third-grade (51.72%). And 69.12% of the questionnaires showed these hospitals could only carry out painless gastroscopy and/or colonoscopy, while 80.81% showed the number of the mean painless endoscopy cases was 0-30 per day; 47.23% of the respondents working in digestive endoscopy center had to complete the anesthesia procedure alone, and 35.83% of the respondents illustrated their digestive endoscopy centers had established the post anesthesia care unit; 62.97% were equipped with anesthesia apparatus or ventilator; 89.96% were equipped with tracheal intubation tool; and 21.44% were equipped with defibrillator. Among them, 25.79% did not prepare rescue medicines regularly in digestive endoscopy center. Propofol was the most frequently used anesthetic, and composited fentanyl was at the highest use rate for gastrointestinal endoscopy. Respondents who used electrocardiogram, non-invasive blood pressure and pulse oxygen saturation the least to monitor during painless gastroscopy and colonoscopy took up 43.48% and 46.08% respectively. ConclusionPainless digestive endoscopy needs further development and standardization with the regulation of related guidelines and standardized residents training.
目的:观察舒芬太尼复合异丙酚自控镇静镇痛在结肠镜检查中的效果及不良反应,从而探讨该方法的安全性和有效性。方法:行无痛纤维结肠镜检查的患者60例,随机分为两组:自控镇痛/镇静组和静脉复合全麻醉组,每组30例。自控镇痛/镇静组首先缓慢静脉注射舒芬太尼0.12 μg/kg,随之接电子自控镇痛泵,负荷量设定为0.5 mg/kg,以4 mg/kg·h的速度持续泵入异丙酚(10 mg/mL),术中按压1次自控手柄可快速推注异丙酚1 mL。静脉复合全麻醉组首先静脉缓慢推注芬太尼1 μg/kg,咪唑安定0.02 mg/kg, 2 min后缓慢推注异丙酚0.8～1 mg/kg。术中间断给予异丙酚以维持听觉诱发电位指数(AAI)于30～40之间。结果:静脉复合全麻醉组的MAP较检查前明显下降且较自控镇痛/镇静组下降更为明显且具有统计学意义(Plt;0.05)。自控镇痛/镇静组的呼吸频率较静脉复合全麻醉组下降明显且在T3时间点具有统计学意义(Plt;0.05)。自控镇痛/镇静组患者OAA/S评分达5分和Aldrete评分达9分的时间均较静脉复合全麻醉组明显缩短(1.4±1.3 VS 3.9±1.7和 2.9±1.7 VS 5.7±1.7)(Plt;0.05)。两组的内镜医师和患者满意度评分无统计学差异(P＞0.05)。结论:自控镇静镇痛能够比传统的静脉全身麻醉提供更良好的循环系统稳定性,更迅速的麻醉后恢复,是结肠镜检查镇静镇痛的理想和安全方法。
【摘要】 目的 探讨腰硬联合麻醉复合丙泊酚恒速输注清醒镇静的可行性、理想的药物剂量、术中知晓情况以及麻醉质量和效果。 方法 收集2009年3-12月480例美国麻醉医师协会（ASA）Ⅰ～Ⅲ级拟在腰硬联合麻醉下行下腹部、会阴部、下肢手术的患者480例，随机分为咪达唑仑组（M组）、丙泊酚Ⅰ组（PA组）、丙泊酚Ⅱ组（PB组）、丙泊酚Ⅲ组（PC组），每组各120例。四组患者均于腰2-3或腰3-4行腰硬联合麻醉，蛛网膜下腔注入轻比重0.2 %布比卡因12～15 mg，麻醉平面确切后，M组予以咪达唑仑0.04~0.06 mg/kg，PA组先予以负荷量丙泊酚0.50 mg/kg再以2.00 mg/（kg•h）剂量持续泵注，PB组予以负荷量丙泊酚0.75 mg/kg再以3.00 mg/（kg•h）剂量持续泵注，PC组予以负荷量丙泊酚1.00 mg/kg再以3.75 mg/（kg•h）剂量持续泵注。观察患者给药前（T0）、给药1（T1）、3（T2）、5（T3）、10（T4）、30（T5）、60 min（T6）各时点血流动力学平均动脉血压（MAP）、心率（HR）的变化、脑电双频指数（BIS）值及镇静评分、术中所看到的图片的回忆及不良反应。 结果 各组在给予镇静药后MAP、HR均有所下降，但测量值的变化在正常范围内；在T3时间点，各组BIS值及镇静/警醒OAA/S评分降低，与T0比较，差异有统计学意义（Plt;0.05）；与其他3组比较，在T4、T5、T6时点PC组BIS值与OAA/S评分降低，差异有统计学意义（Plt;0.05），PC组的镇静遗忘满意率高于其他3组；各组间未见发生严重的舌后坠、呼吸暂停和血氧饱和度（SpO2）lt;90%。 结论 在下腹部、下肢手术中，应用腰硬联合麻醉复合1.00 mg/kg负荷量的丙泊酚继而以3.75 mg/（kg•h）剂量持续泵注，可取得良好的镇静效果，不良反应小。【Abstract】 Objective To investigate the feasibility, ideal dose, intra-operative awareness as well as the quality and effectiveness of constant infusion of propofol under combined spinal-epidural anesthesia (CSEA) for conscious sedation. Methods A total of 480 patients at ASA grade Ⅰ-Ⅲ to be operated in the lower abdomen, perineum and lower limbs under CSEA from March to December 2009 were randomly divided into four groups: midazolam group (M group), propofol group Ⅰ (PA group), propofol group Ⅱ (PB group), and propofol group Ⅲ (PC group), with 120 patients in each group. All four groups of patients underwent CSEA at L2-3 or L3-4 and accepted pinal injection of 12-15 mg of 0.2% hypobaric bupivacaine. After the anesthetic plane was confirmed, patients in M group accepted 0.04-0.06 mg/kg of midazolam; patients in PA group accepted propofol at a loading dose of 0.50 mg/kg followed by continuous infusion at a dose of 2.00 mg/(kg•h); patients in PB group accepted propofol at a loading dose of 0.75 mg/kg followed by continuous infusion at a dose of 3.00 mg/(kg•h); patients in PC group accepted propofol at a loading dose of 1.00 mg/kg followed by continuous infusion at a dose of 3.75 mg/(kg•h). The change of hemodynamics including the mean arterial pressure (MAP) and the heart rate (HR), bispectral index (BIS) values, sedation scores, memory of pictures seen during operation and adverse effects before drug administration (T0), at minute 1 (T1), 3 (T2), 5 (T3), 10 (T4), 30 (T5) and 60 (T6) after drug administration were observed. Results MAP and HR decreased in all the four groups after administration of sedatives, but the changes of measured values were within normal ranges. BIS value and the Observer’s Assessment of Alertness and Sedation (OAA/S) scale decreased in all groups at T3, compared with those at T0 (Plt;0.05). Compared with the other 3 groups, BIS valueand OAA/S scale were significantly lower in PC group at T4, T5 and T6 (Plt;0.05), and the satisfaction rate of sedation and amnesia was much higher. No serious glossocoma, apnea and SpO2 below 90% was observed in all the four groups. Conclusion During the surgery of lower abdomen and lower limbs, application of CSEA combined with propofol at a loading dose of 1.00 mg/kg followed by continuous infusion at a dose of 3.75 mg/(kg•h) can achieve a good sedative effect, with little side effect.
【摘要】 目的 观察丙泊酚在重症监护室（ICU） 外科术后对患者的镇静效果及作用。 方法 2006年7月-2008年7月，对行外科手术后在ICU观察室采用丙泊酚镇静的45例患者的镇静效果、停药苏醒时间及给药前后呼吸、循环参数的变化进行观察，并与治疗前进行比较。 结果 丙泊酚镇静起效快，镇静治疗后大多数患者开始血压有所下降（Plt;0.05）但不久恢复正常，所有患者心率、呼吸频率、血氧饱和度无明显变化（Pgt;0.05），停药后苏醒快。 结论 丙泊酚是外科术后患者较理想的镇静剂，但应根据患者情况调整给药速度、剂量及时间。 【Abstract】 Objective To observe the sedative effect of propofol on the patients after surgical operations in intensive care unit (ICU). Methods Forty-five patients underwent the injection with propofol after surgical operations in ICU from July 2006 to July 2008. The sedative efficacy, recovery time after the propofol administration, and changes of respiratory, circulate parameter before and after medication were observed, which were compared with those before the treatment. Results The sedative reactive time of propofol was short. Most of the patients had decreased blood pressure after injection with propofol (Plt;0.05) but recovered soon. The heart rate, respiratory rate, and pulse oxygen saturation did not significantly changed (Pgt;0.05). The recovery time was short after propofol administration was stopped. Conclusion Propofol is an effective sedative for the patients after surgical operations in ICU, but the medicated speed, amount and time according to state of the patients should be adjusted.
目的 评价重症急性左心衰竭患者机械通气时采用咪达唑仑与吗啡联合持续镇静的效果。 方法 选择2007年4月－2010年4月在重症医学科（ICU）进行有创机械通气的重症急性左心衰竭患者86例，随机均分为咪达唑仑组（A组）、咪达唑仑联合吗啡组（B组）。采用Ramsay镇静评分，使每例患者镇静水平达RamsayⅢ～Ⅳ级。观察起效时间、镇静时间、停药后苏醒时间和停药后拔管时间；监测镇静12 h后的血气分析及血流动力学参数的变化。 结果 B组起效时间、镇静时间、停药后苏醒时间和停药后拔管时间明显短于A组（P＜0.05）。且镇静12 h后B组血气分析及血流动力学较A组明显改善（P＜0.05）。 结论 重症急性左心衰竭患者机械通气时使用咪达唑仑联合吗啡镇静能达到满意镇静效果，同时改善重症急性左心衰竭患者的低氧血症和高碳酸血症。