中华消化内镜杂志
中華消化內鏡雜誌
중화소화내경잡지
CHINESE JOURNAL OF DIGESTIVE ENDOSCOPY
2009年
5期
264-267
,共4页
老年人%内窥镜检查,胃肠道%麻醉%全身%安全
老年人%內窺鏡檢查,胃腸道%痳醉%全身%安全
노년인%내규경검사,위장도%마취%전신%안전
Aged%Endoscopy,gastrointestinal%Anesthesia,general%Safety
目的 评价芬太尼和异丙酚静脉麻醉在≥70岁老年患者胃肠镜检查中的安全性.方法 回顾分析826例采用静脉麻醉下胃肠镜检查且年龄≥70岁老年患者的临床资料,按年龄分成2组:A组,70～80岁,618例,其中接受胃镜检查者342例,肠镜检查者276例;B组,>80岁,208例,其中接受胃镜检查者112例,肠镜检查者96例.另随机抽取同期接受静脉麻醉下胃肠镜检查的年龄<70岁的患者600例(胃镜检查者400例,肠镜检查者200例)作对照.总结分析胃肠镜检查情况,比较相同检查方式下各组血压、心率、血氧饱和度(SpO<,2>)变化情况以及不良反应发生情况.结果 所有接受静脉麻醉患者均未发生胃肠镜检查穿孔及死亡等严重事件,亦无一例因麻醉并发症终止胃肠镜检查,均能达到胃肠镜检查的满意镇静程度.对应检查方式下,随年龄增加异丙酚用量均减小:胃镜检查时,异丙酚平均剂量A组为(54.22±21.36)mg,B组为(40.22±12.46)mg,对照组为(86.44±34.26)mg;肠镜检查时,A组为(82.56±40.64)mg,B组为(45.36±15.44)mg,对照组为(102.23±46.32)mg.相同检查方式下各组心率、血压变化程度不大,组内前后两观察时点比较差异均无统计学意义(P>0.05);但静脉麻醉对老年患者SpO<,2>影响较大,A组和B组共18例出现SpO<,2><90%,主要为唾液误吸入气管引起呛咳所致,予面罩呼吸气囊加压吸氧后短期内恢复.结论 在严格控制适应证的条件下,适当剂量麻醉药静脉麻醉下老年患者胃肠镜检查是安全的、可行的.
目的 評價芬太尼和異丙酚靜脈痳醉在≥70歲老年患者胃腸鏡檢查中的安全性.方法 迴顧分析826例採用靜脈痳醉下胃腸鏡檢查且年齡≥70歲老年患者的臨床資料,按年齡分成2組:A組,70～80歲,618例,其中接受胃鏡檢查者342例,腸鏡檢查者276例;B組,>80歲,208例,其中接受胃鏡檢查者112例,腸鏡檢查者96例.另隨機抽取同期接受靜脈痳醉下胃腸鏡檢查的年齡<70歲的患者600例(胃鏡檢查者400例,腸鏡檢查者200例)作對照.總結分析胃腸鏡檢查情況,比較相同檢查方式下各組血壓、心率、血氧飽和度(SpO<,2>)變化情況以及不良反應髮生情況.結果 所有接受靜脈痳醉患者均未髮生胃腸鏡檢查穿孔及死亡等嚴重事件,亦無一例因痳醉併髮癥終止胃腸鏡檢查,均能達到胃腸鏡檢查的滿意鎮靜程度.對應檢查方式下,隨年齡增加異丙酚用量均減小:胃鏡檢查時,異丙酚平均劑量A組為(54.22±21.36)mg,B組為(40.22±12.46)mg,對照組為(86.44±34.26)mg;腸鏡檢查時,A組為(82.56±40.64)mg,B組為(45.36±15.44)mg,對照組為(102.23±46.32)mg.相同檢查方式下各組心率、血壓變化程度不大,組內前後兩觀察時點比較差異均無統計學意義(P>0.05);但靜脈痳醉對老年患者SpO<,2>影響較大,A組和B組共18例齣現SpO<,2><90%,主要為唾液誤吸入氣管引起嗆咳所緻,予麵罩呼吸氣囊加壓吸氧後短期內恢複.結論 在嚴格控製適應證的條件下,適噹劑量痳醉藥靜脈痳醉下老年患者胃腸鏡檢查是安全的、可行的.
목적 평개분태니화이병분정맥마취재≥70세노년환자위장경검사중적안전성.방법 회고분석826례채용정맥마취하위장경검사차년령≥70세노년환자적림상자료,안년령분성2조:A조,70～80세,618례,기중접수위경검사자342례,장경검사자276례;B조,>80세,208례,기중접수위경검사자112례,장경검사자96례.령수궤추취동기접수정맥마취하위장경검사적년령<70세적환자600례(위경검사자400례,장경검사자200례)작대조.총결분석위장경검사정황,비교상동검사방식하각조혈압、심솔、혈양포화도(SpO<,2>)변화정황이급불량반응발생정황.결과 소유접수정맥마취환자균미발생위장경검사천공급사망등엄중사건,역무일례인마취병발증종지위장경검사,균능체도위장경검사적만의진정정도.대응검사방식하,수년령증가이병분용량균감소:위경검사시,이병분평균제량A조위(54.22±21.36)mg,B조위(40.22±12.46)mg,대조조위(86.44±34.26)mg;장경검사시,A조위(82.56±40.64)mg,B조위(45.36±15.44)mg,대조조위(102.23±46.32)mg.상동검사방식하각조심솔、혈압변화정도불대,조내전후량관찰시점비교차이균무통계학의의(P>0.05);단정맥마취대노년환자SpO<,2>영향교대,A조화B조공18례출현SpO<,2><90%,주요위타액오흡입기관인기창해소치,여면조호흡기낭가압흡양후단기내회복.결론 재엄격공제괄응증적조건하,괄당제량마취약정맥마취하노년환자위장경검사시안전적、가행적.
Objective To evaluate the safety of conscious venous anesthesia with fentanyl and propofol in elderly patients over 70 during gastrointestinal endoscopy. Methods Clinical data of 826 elderly patients over 70, who underwent gastrointestinal endoscopy with venous anesthesia, were retrospectively analyzed. The patients were divided into 2 groups according to their ages, with 618 patients aging from 70 to 80 in group A, in which 342 received endoscopy and 276 underwent colonoscopy, and 208 patients older than 80 in group B, in which 112 underwent endoscopy and 96 had colonoscopy. Another cohort of 600 patients younger than 70, who underwent venous anesthetic endoscopy during the same time period, was randomly selected as the control group, in which 400 patients received endoscopy and 200 had colonoscopy. Blood pressure, heart rate, peripheral oxygen saturation (SpO2) and adverse reaction were monitored in each patient during the procedure and compared among different groups. Results No procedure-related perforation or sedation-related mortality was observed, and no procedure was terminated clue to sedation complication. The average dosages of propofol used in procedure of endoscopy in groups A, B and control were 54.22±21.36 mg, 40.22±12.46 mg, and 86.44±34.26 mg, respectively. The average dosages of propofol in colonoscopy were 82.56±40.64 mg, 45.36±15.44 mg and 102.23±46.32 mg, respectively. With same procedure, there was no significant difference in heart rate and blood pressure among different groups, nor was there any difference in these variables before and after the procedure in each group (P>0.05). Sedation exerted more influence on SpO<,2> in elderly patients. A total of 18 cases in groups A and B experienced SpO<,2> <90%, which was mainly due to aspiration of saliva and relieved by oxygen inhalation. Conclusion Under appropriate monitor, it is safe and feasible to give conscious sedation to elderly patients over 70 during gastroimestinal endoscopy.
