摘要
背景对于镇静药如何联合应用可以使认知功能障碍最小化并提供良好的术中镇静状态，目前尚未有定论。我们希望确认的是：对于择期门诊肠镜检查的患者来说，与丙泊酚联合应用咪达唑仑和（或）芬太尼相比，单用丙泊酚麻醉在患者出院时是否能够减轻认知功能障碍。方法选择200例门诊肠镜检查的成年患者，随机分为静脉镇静单用丙泊酚组和丙泊酚联合咪达唑仑和（或）芬太尼组。在给予镇静药之前使用计算机化CogState测验（CogstateTM．，Melbourne，Auslralia）检测患者的基础认知功能。整个过程记录镇静药的用量、镇静深度（通过双频指数和警觉镇静评分判定）、并发症和可治疗性。患者从镇静状态恢复后立即询问可回忆出的内容，并在患者出院时重复测试一次，记录患者的恢复时间、恢复质量以及护理满意程度。结果在丙泊酚加辅助药组，84例接受芬太尼50μg（25-100）[中位数（范围）]和57例接受咪达唑仑2mg（0．5。10）。患者出院时认知功能不如基准水平。而两组在出院水平和基准水平之间认知功能的变化上，组间无显著差异。出院时，18．5％的患者认知功能受损的程度相当于血液中含有0．05％乙醇浓度。丙泊酚联合咪达唑仑和（或）芬太尼比单用丙泊酚能使手术镇静状态更好，手术时间更短。两组在恢复时间、唤醒、梦境、恢复质量和患者对护理的满意度也相似。应用咪达唑仑大于2mg是预测患者出院时出现认知功能障碍的一个因素。结论在择期的门诊肠镜检查时，患者出院时普遍存在认知功能障碍。丙泊酚联合咪达唑仑和（或）芬太尼镇静并没有比单独使用丙泊酚产生更严重的认知功能障碍。此外，添加辅助药使结肠镜检查更轻松，且不增加并发症的发生率，不延长恢复时间。
BACKGROUND： The sedative drug combination that produces minimal cognitive impairment and opti- mal operating conditions during colonoscopy has not been determined. We sought to determine if the use of propofol alone results in less cognitive impairment at discharge than the use of propofol plus midazolam and/or fentanyl in patients presen- ting for elective outpatient colonoscopy. METHODS： Two hundred adult patients presenting for elective outpatient colonoscopy were randomized to receive propofol alone or propofol plus midazolam, and/or fentanyl for IV sedation. Base- line cognitive function was measured using the computerized CogState test battery （CogstateTM, Melbourne, Australia） be- fore sedation. During the procedure, sedative drug doses, depth of sedation （via the bispectral indexand observer＇s assess- ment of alertness/sedation score）, complications, and treatabilitywere recorded. Patients were interviewed about recall im- mediately after emergingfrom sedation, and cognitive testing was repeated at hospital discharge. Recoverytimes, quality of recovery, and satisfaction with care were also recorded. RESULTS： In the propofol plus adjuvants group, 84 patients re- ceived fentanyl 50 g （25 - I00） （median [ rangel ） and 57 patients received midazolam 2 mg （0.5 - 10）. Patients＇ cognitive function at discharge was worse than their performance at baseline. However, the changes in cognitive function between discharge and baseline were not significantly different between the two groups. At discharge, 18. 5% of patients were cog- nitively impaired to an extent equivalent to a bloodalcohol concentration of 0. 05 %. Sedation with propofol plus midazo-lain and/or fentanyl produced better operating conditions than sedation with propofol alone and was associated with shor- ter procedure times. Recovery times, recaU, dreaming, quality of recovery, and patient satisfaction with care were similar be- tween the groups. Administration of 〉2 mg of midazolam was a predictor of impaired cognitive function at discharge. CONCLUSIONS： Significant cognitive impairment was common at discharge from elective outpatient colonoscopy. Howev- er, the addition of midazolam and/or fentanyl to propofol sedation did not result in more cognitive impairment than the use of propofol alone. Furthermore, the use of adiuvants improved the ease of colonoscopy without increasing the rate of com- plications or prolonging early recovery times.
出处
《麻醉与镇痛》
2011年第6期87-96,共10页
Anesthesia & Analgesia
