| Objectives:To explore the titration of propofol plasma drug concentration in painless gastrointestinal endoscopy to personalize the optimal target control concentration of propofol plasma.Methods:Select 180 patients planned to undergo a painless EGD+colonoscopy in the First Affiliated Hospital of Kunming Medical University(ASA classification Ⅰ/Ⅱ),and randomly divide them into three groups,A,B,and C,with 60 patients in each group.Give fentanyl(1ug/kg)2 minutes before propofol infusion,then use TCI infusion pump to select Marsh mode to target-controlled infusion to the patient by titration,and record the plasma when the patient’s consciousness disappears(the eyelash reflex disappears)Drug concentration(Cp),adjust the plasma target control concentration(Cpt)to group A(Cp),group B(1.5Cp),and group C(2Cp)before entering the lens as the plasma drug concentration for maintaining anesthesia.When each group of patients Endoscopy was started after the plasma drug concentration reached the set target concentration.The three groups of patients maintained this set concentration until the colonoscopy reached the ileocecal valve and stopped pumping propofol.Monitor the heart rate,mean arterial pressure,and pulse oxygen saturation during the examination of the three groups of patients,and record the lowest MAP,highest MAP,lowest HR,highest HR,and lowest SpO2 of the three groups of patients;record the frequency of hypotension and bradycardia in the three groups,Frequency of use of ephedrine and atropine,frequency of motor reactions and hypoxemia,examination time,wake-up time,dosage of propofol per unit weight,endoscopy doctors and patients’ satisfaction with the quality of anesthesia,etc.Results:Comparison of body movement and coughing reaction:The incidence of body movement and coughing reaction of patients in group A was significantly higher than that of group B and C(p<0.01).There was no difference in body movement and coughing reaction between groups B and C.Statistical significance(p>0.05);comparison of hypoxemia:the incidence of hypoxemia in group B was significantly lower than that in groups A and C(p<0.01),the incidence of hypoxemia in groups A and C No significant difference(p>0.05);Comparison of wake-up time:the wake-up time of group C patients was significantly longer than that of group A and B(p<0.01),the wake-up time of group B patients was longer than that of group A,the difference was statistically significant(p<0.01);unit weight Comparison of the dosage of propofol;The dosage of propofol in group C was significantly more than that of group A and B(p<0.01),and the dosage of propofol in group B was more than that of group A(p<0.01);hemodynamic comparison:The lowest MAP and lowest HR of group C were significantly lower than those of group A and group B(p<0.01),while there was no statistical difference in the lowest MAP and lowest HR between group A and group B(p>0.05);group A The highest MAP and highest HR of the patients were significantly higher than those of the B and C groups(p<0.05).There was no significant difference in the highest HR between group B and C(p>0.05);compared with the lowest SpO2 during the operation,group C was significantly lower than that of group A The difference between group B and group B is statistically significant(p<0.01).The minimum SpO2 of group A and group B is similar,and the difference is not statistically significant(p>0.05);satisfaction comparison:endoscopy doctors’satisfaction with the quality of anesthesia Group B was significantly higher than group A and group C(p<0.01).There was no significant difference in the satisfaction of endoscopy doctors in group A and C in the quality of anesthesia(p>0.05);while the satisfaction of the three groups of patients with the quality of anesthesia Similar,no significant statistical difference(p>0.05);general information and examination time of the three groups of patients were compared between the groups,and the differences were not statistically significant(p>0.05).Conclusion(s):Target-controlled infusion of propofol by titration in painless gastrointestinal endoscopy can guide individualized plasma optimal target concentration,and the plasma drug concentration when the consciousness of 1.5 times the titration disappears(the eyelash reflex disappears)is the most appropriate At this concentration,it can not only ensure the appropriate depth of anesthesia,increase the satisfaction of endoscopy doctors and patients,but also reduce the incidence of adverse reactions,and the recovery time does not significantly extend.This indeed provides us with a new idea for anesthesia in painless endoscopy. |
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