【摘要】 目的 确定纳布啡复合丙泊酚麻醉用于成人患者行无痛胃镜检查时纳布啡的半数有效剂量(ED₅₀)和95%有效剂量(ED₉₅)。方法 选取需做无痛胃镜检查的成人患者75例，随机分为5组(N₀、N_0.05、N_0.1、N_0.15和N_0.2组)，每组纳布啡剂量分别为0、0.05、0.1、0.15和0.2 mg/kg。每组患者静脉注射相应剂量纳布啡后，静脉TCI注射丙泊酚至患者BIS值维持在50～65之间，2 min后行胃镜检查。记录患者在麻醉诱导前（T₀）、胃镜置入前1 min（T₁）和胃镜置入后1 min（T₂）的心率（HR）和平均动脉压（MAP），以及双频脑电指数（BIS）值。记录每组患者发生不耐受胃镜检查指标（呛咳反射、吞咽反射、干呕反射、肢动反应）的例数；所有不耐受胃镜检查指标均未出现的患者为胃镜置入成功病例。计算纳布啡用于无痛胃镜检查时的ED₅₀、ED₉₅及其95%CI。结果 组内比较，在T₁时，5组的HR、MAP皆较T₀下降（P<0.05）；在T₂时，N₀、N_0.05、N0.1组的HR、MAP皆较T1升高（P<0.05），而N_0.15、N_0.2组的HR、MAP不变（P>0.05）。与N₀、N_0.05组比较，N_0.15、N₍0.2_组的吞咽、干呕和体动发生率明显降低（P<0.05）;N0.15、N0.2组的胃镜置入成功率明显升高（P<0.05）。纳布啡复合丙泊酚麻醉用于成人患者行胃镜检查时，纳布啡的ED₅₀、ED₉₅及其95%CI分别为0.078（0.056～0.098）mg/kg和0.162（0.134～0.217）mg/kg。结论 纳布啡复合丙泊酚麻醉用于成人无痛胃镜检查具有良好的麻醉效果和安全性；纳布啡的ED₅₀和ED₉₅分别为0.078和0.162 mg/kg。更多还原

【Abstract】 Objective To evaluate the half effective dose(ED₅₀ and 95% effective dose(ED95) of nalbuphine combined with propofol anesthesia for painless gastroscopy in adult patients. Methods 75 patients undergoing painless gastroscopy in our hospital were randomly divided into 5 groups(group N0, N0.05, N0.1, N0.15and N0.2),following the dosage of nalbuphine in each group with 0, 0.05, 0.1, 0.15 and 0.2 mg/kg. Then propofol was given by TCI to all groups and BIS value was maintained between 50 and 65. Gastroscopy was performed 2 minutes later.. Heart rate（HR） and mean arterial pressure（MAP） were recorded at baseline（T0）, 1 min before undergoing gastroscopy（T1） and 1 min after undergoing gastroscopy（T2）, as well as BIS value. The number of patients with any one of the intolerance indexes（coughing, retching, swallowing and limb movement） during undergoing gastroscopy was recorded in each group. The patients without any one of the four intolerance indexes were successful cases in painless gastroscopy, and the number of successful cases was recorded. The ED50and ED95of nalbuphine combined with propofol for painless gastroscopy were calculated. Results Compared with T0, HR and MAP decreased in five groups at T1（P<0.05）. Compared with T1, HR and MAP increased in group N0, N0.05and N0.1at T2（P<0.05）, while HR and MAP remained unchanged in group N0.15and N0.2at T2（P>0.05）. Compared with group N0or N0.05, the incidence of swallowing, retching and limb movement were significantly lower in group N0.15and N0.2（P<0.05）. The successful rate of painless gastroscopy in group N0.15and N0.2were significantly more increased than that of group N0and N0.05（P<0.05）. When combined with propofol, the ED50, ED95and 95%confidence intervals of nalbuphine for gastroscopy were 0.078（0.056-0.098） mg/kg and 0.162（0.134-0.217）mg/kg, respectively. Conclusion Nalbuphine combined with propofol anesthesia is effective and safe for painless gastroscopy in adult patients, and the ED50and ED95of nalbuphine for painless gastroscopy are 0.078 mg/kg and0.162 mg/kg, respectively.</sub>更多还原