丙泊酚在不同Child-Pugh分级肝硬化患者无痛胃肠镜检查中的麻醉效果及不良反应分析

高放; 常越; 李海

doi:10.3969/j.issn.1001-5256.2018.07.016

丙泊酚在不同Child-Pugh分级肝硬化患者无痛胃肠镜检查中的麻醉效果及不良反应分析

DOI: 10.3969/j.issn.1001-5256.2018.07.016

中国人民武装警察部队后勤学院附属医院肝胆胰脾科

基金项目:

国家自然科学基金项目(81173393)；武警后勤学院创新团队基金项目(WHTD201310)；

详细信息

中图分类号: R614
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出版历程
- 收稿日期: 2018-01-15
- 出版日期: 2018-07-20

Anesthetic effect and adverse reactions of propofol in painless gastrointestinal endoscopy in patients with different Child-Pugh classification of liver cirrhosis

Department of Hepatopancreatobiliary and Splenic Medicine, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces

Research funding:

摘要

摘要: 目的观察丙泊酚在不同肝硬化患者无痛胃肠镜检查中的麻醉效果及不良反应分析。方法收集2015年2月-2017年8月于中国人民武装警察部队后勤学院附属医院接受丙泊酚麻醉的胃肠镜检查肝硬化患者342例。根据术前Child-Pugh分级,将患者分为Child-Pugh A组（n=224）、Child-Pugh B组（n=94）、Child-Pugh C组（n=24）。比较3组患者麻醉效果和不良反应情况。计量资料多组间比较采用方差分析,进一步两两比较使用SNK-q检验比较;计数资料组间比较使用χ2检验或KruskalWallis H秩和检验,进一步两两比较采用Ridit分析。结果患者肝功能越差麻醉剂总用量越少,3组差异有统计学意义（F=4.401,P=0.017）,肝功能越差意识消失时间越短,Child-Pugh C组患者意识消失时间短于Child-Pugh A、B组,3组差异具有统计学意义（F=9.440,P=0.001）。3组均未出现丙泊酚过敏、丙泊酚输注综合征、惊厥样反应等不良反应。3组患者麻醉期间注射部位疼痛、心律失常、呼吸抑制发生差异均无统计学意义（P值均>0...
- 肝硬化 /
- 二异丙酚 /
- 胃镜检查 /
- 麻醉,静脉
Abstract: Objective To investigate the anesthetic effect and adverse reactions of propofol in painless gastrointestinal endoscopy in patients with varying degrees of liver cirrhosis. Methods A total of 342 patients with liver cirrhosis who underwent gastrointestinal endoscopy under propofol anesthesia in The Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces from February 2015 to August2017 were enrolled. According to the Child-Pugh class before surgery, the patients were divided into Child-Pugh A Group ( n = 224) , Child-Pugh B group ( n = 94) , and Child-Pugh C Group ( n = 24) . The three groups were compared in terms of anesthetic effect and adverse reactions. An analysis of variance was used for comparison of continuous data between multiple groups, and the SNK-q test was used for further comparison between any two groups; the chi-square test or the Kruskal-Wallis H rank sum test was used for comparison of categorical data between multiple groups, and a Ridit analysis was used for further comparison between any two groups. Results Compared with the Child-Pugh A group and the Child-Pugh B group, the Child-Pugh C group had a significantly smaller amount of propofol used ( F =4. 401, P = 0. 017) and a significantly shorter time of loss of consciousness ( F = 9. 440, P = 0. 001) . No patient experienced adverse reactions such as allergy to propofol, propofol infusion syndrome, and convulsion-like reactions. There were no significant differences in the incidence rates of pain at the injection site, arrhythmia, and respiratory depression between the three groups ( all P > 0. 05) . There was a significant difference in the reduction in blood pressure between the three groups ( H = 3. 795, P < 0. 001) , and the Child-Pugh B group had significantly lower blood pressure than the other two groups ( both P < 0. 05) . Conclusion Propofol has a safe anesthetic effect in painless gastrointestinal endoscopy in patients with varying degrees of liver cirrhosis and does not have serious adverse effects. Patients with poorer liver function tend to have a smaller amount of propofol used, and the change in blood pressure should be taken seriously during surgery.
- live cirrhosis /
- propofol /
- gastroscopy /
- anesthesia, intravenous

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参考文献(18)

[1]WANG ZJ, MENG XH.Sedative effect and safety of small doses of Sufentanil combined with Propofol in painless gastroscopy[J].Chin J Geriatr, 2015, 34 (8) :884-886. (in Chinese) 王振静, 孟宪慧.小剂量舒芬太尼复合丙泊酚在无痛胃镜检查中的镇静效果及安全性[J].中华老年医学杂志, 2015, 34 (8) :884-886.

[2]ZHAO L, XU L.Efficacy and safety of endoscopic esophageal variceal ligation in esophageal variceal bleeding in elderly patients with hepatic cirrhosis[J].Chin J Dig, 2015, 35 (6) :361-366. (in Chinese) 赵莉, 许乐.老年肝硬化患者内镜下食管静脉曲张套扎术的效果及安全性[J].中华消化杂志, 2015, 35 (6) :361-366.

[3]BELLETTI A, CASTRO ML, SILVETTI S, et al.The effect of inotropes and vasopressors on mortality:A meta-analysis of randomized clinical trials[J].Br J Anaesth, 2015, 115 (5) :656-675.

[4]ZHANG XH, YANG WY, FU RQ.The study of perioperative hemodynamic and homeostasis changes and anesthesia management in patients with end-stage liver OLT[J].J Clin Experimental Med, 2016, 15 (20) :2013-2016. (in Chinese) 张晓红, 杨旺燕, 傅润乔.终末期肝病原位肝移植术围手术期的血流动力学和内稳态变化及麻醉处理[J].临床和实验医学杂志, 2016, 15 (20) :2013-2016.

[5] GUO QT.Safety of painless gastroscopy versus conventional gastroscopy in patients with hypertension[J].Chongqing Med, 2017 (A02) :302-303. (in Chinese) 郭庆涛.高血压患者行无痛胃镜与普通胃镜检查的安全性分析[J].重庆医学, 2017 (A02) :302-303.

[6]FICKI S, FISCHER K, PETERSEN N, et al.Dimensional evaluation of different ridge preservation techniques:A randomized clinical study[J].Int J Periodont Rest, 2017, 37 (3) :402-410.

[7]WANG XL, REN L, REN HY, et al.A randomized controlled trial of prophylactic use of pinaverium bromide before colonoscopy[J].Chin J Dig, 2017, 37 (5) :338-340. (in Chinese) 王晓林, 任莉, 任宏宇, 等.结肠镜检查前预防性应用匹维溴铵的随机对照研究[J].中华消化杂志, 2017, 37 (5) :338-340.

[8]TURNER MA, DAVIS JM.Propofol as an adjunct for neonatal intubation:The contribution of clinical pharmacology[J].J Pediatr, 2016, 179:9-10.

[9]XIE SC, LI W, LIAO P, et al.Research progress of general anesthesia in the pharmacogenetics[J].Chin J Clin Pharmacol Ther, 2018, 23 (2) :217-222. (in Chinese) 谢商宸, 李玮, 瘳萍, 等.全身麻醉药物遗传药理学研究进展[J].中国临床药理学与治疗学, 2018, 23 (2) :217-222.

[10]LI XN, ZHANG W.Effects of liver function in patients with liver cirrhosis and virus B hepatitis on drug half-life and an-algesic effect of target controlled infusion of remifentanil[J].J China Pharm, 2016, 27 (20) :2822-2824. (in Chinese) 李晓宁, 张卫.乙型病毒性肝炎肝硬化患者肝功能状况对靶控输注瑞芬太尼药物半衰期和镇痛效果的影响[J].中国药房, 2016, 27 (20) :2822-2824.

[11]ZHANG HK, MENG XL, LI HL, et al.Current status of malnutrition and its association with prognosis in hospitalized patients with decompensated liver cirrhosis[J].J Clin Hepatol, 2016, 32 (6) :1100-1103. (in Chinese) 张辉凯, 孟祥林, 李海雷, 等.失代偿期肝硬化住院患者营养不良情况及其与预后的关系[J].临床肝胆病杂志, 2016, 32 (6) :1100-1103.

[12]XIONG Q, ZHOU YF, YANG GW.Changes in the levels of carbohydrate antigen 125 and albumin in serum and ascites and their significance in patients with liver cirrhosis complicated by spontaneous bacterial peritonitis[J].Shandong Med J, 2016, 56 (13) :43-44. (in Chinese) 熊琴, 周英发, 杨国威.肝硬化并自发性细菌性腹膜炎患者血清和腹水中CA125、白蛋白水平变化及意义[J].山东医药, 2016, 56 (13) :43-44.

[13]WU YJ, XU MY, LU LG.Rational drug use in patients with liver cirrhosis[J].Chin J Dig, 2014, 34 (9) :643-645. (in Chinese) 吴叶娇, 徐铭益, 陆伦根.肝硬化患者的药物合理应用[J].中华消化杂志, 2014, 34 (9) :643-645.

[14]HERNANDEZRABAZA V, CABRERAPASTOR A, TAOROGONZALEZ L, et al.Hyperammonemia induces glial activation, neuroinflammation and alters neurotransmitter receptors in hippocampus, impairing spatial learning:Reversal by sulforaphane[J].J Neuroinflammation, 2016, 13 (1) :1-11.

[15]YAN R, MA ZR, CHEN XX.Influence of blood ammonia on awakening time from propofol anesthesia in rats with liver cirrhosis[J].J Ningxia Med Univ, 2012, 34 (5) :459-461. (in Chinese) 闫瑞, 马增瑞, 陈学新.血氨对肝硬化大鼠丙泊酚麻醉苏醒时间的影响[J].宁夏医科大学学报, 2012, 34 (5) :459-461.

[16]ZENG XY, XU TS, XU JG, et al.Clinical efficacy and safety of dexmedetomidine combined with propofol on analgesic coloscopy[J].Chin J Clin Pharmacol, 2015, 31 (10) :796-798. (in Chinese) 曾雪云, 徐天生, 徐建光, 等.右美托咪定复合丙泊酚用于无痛纤维结肠镜检查的临床疗效及安全性评价[J].中国临床药理学杂志, 2015, 31 (10) :796-798.

[17]LEE M, KWON T, KIM S, et al.Comparative evaluation of the effect of remifentanil and 2 different doses of esmolol on pain during propofol injection:A double-blind, randomized clinical consort study[J].Medicine, 2017, 96 (10) :e6288.

[18]MA JH, HUANG Q, PENG CY, et al.Modification and application of safety management process for patients undergoing painless endoscopy[J].Chin J Dig Endosc, 2013, 30 (12) :712-713. (in Chinese) 马久红, 黄茜, 彭春艳, 等.无痛内镜诊疗患者安全管理流程改进与运用[J].中华消化内镜杂志, 2013, 30 (12) :712-713.

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