Moerman A T, Foubert L A, Herregods L L, Struys M M R F, De Wolf D J, De Looze D A, De Vos M M, Mortier E P
Department of Anaesthesia, Ghent University Hospital, Gent, Belgium.
Eur J Anaesthesiol. 2003 Jun;20(6):461-6. doi: 10.1017/s0265021503000723.
We conducted an open, prospective, randomized study to compare the efficacy, safety and recovery characteristics of remifentanil or propofol during monitored anaesthesia care in patients undergoing colonoscopy.
Forty patients were randomly assigned to receive either propofol (1 mg kg(-1) followed by 10 mg kg (-1) h(-1), n = 20) or remifentanil (0.5 microg kg(-1) followed by 0.2 microg kg(-1) min(-1), n = 20). The infusion rate was subsequently adapted to clinical needs.
In the propofol group, arterial pressure and heart rate decreased significantly from the baseline. These variables remained unchanged in the remifentanil group, but hypoventilation occurred in 55% of patients. Early recovery was delayed in the propofol group (P < 0.002). Recovery of cognitive and psychomotor functions was faster in the remifentanil group. Fifteen minutes after anaesthesia, the Digit Symbol Substitution Test score was 28.6 +/- 12.8 versus 36.2 +/- 9.4 and the Trieger Dot Test score was 25.6 +/- 8.1 versus 18.7 +/- 4.1 in the propofol and remifentanil groups, respectively (both P < 0.05). Patient satisfaction, using a visual analogue scale, was higher in the propofol group (96 +/- 7 versus 77 +/- 21, P < 0.001).
Remifentanil proved efficient in reducing pain during colonoscopy. Emergence times were shorter and the recovery of cognitive function was faster with remifentanil compared with propofol. Remifentanil provided a smoother haemodynamic profile than propofol; however, the frequent occurrence of remifentanil-induced hypoventilation requires the cautious administration of this agent.
我们开展了一项开放性、前瞻性、随机研究，以比较瑞芬太尼与丙泊酚在结肠镜检查患者监护麻醉过程中的疗效、安全性及恢复特征。
40例患者被随机分为两组，分别接受丙泊酚（1mg/kg静脉注射，随后以10mg·kg⁻¹·h⁻¹静脉输注，n = 20）或瑞芬太尼（0.5μg/kg静脉注射，随后以0.2μg·kg⁻¹·min⁻¹静脉输注，n = 20）。随后根据临床需要调整输注速率。
丙泊酚组患者的动脉压和心率较基线显著降低。瑞芬太尼组上述指标无变化，但55%的患者出现通气不足。丙泊酚组早期恢复延迟（P < 0.002）。瑞芬太尼组认知和精神运动功能恢复更快。麻醉后15分钟，丙泊酚组和瑞芬太尼组的数字符号替换测验得分分别为28.6 ± 12.8和36.2 ± 9.4，连线测验得分分别为25.6 ± 8.1和18.7 ± 4.1（均P < 0.05）。采用视觉模拟评分法，丙泊酚组患者满意度更高（96 ± 7比77 ± 21，P < 0.001）。
瑞芬太尼在结肠镜检查中镇痛效果良好。与丙泊酚相比，瑞芬太尼的苏醒时间更短，认知功能恢复更快。瑞芬太尼血流动力学状态比丙泊酚更平稳；然而，瑞芬太尼所致通气不足的频繁发生要求谨慎使用该药。
