CAJ | 학술논문

目的:探讨异丙酚复合咪达唑仑静脉麻醉在小儿上消化道内镜术中的应用特点.方法:ASA Ⅰ～Ⅱ级接受无痛胃镜的497例患者分为小儿组243例(年龄2～14岁)及成人组254例(年龄18～65岁),2组内镜检查前均予咪达唑仑(0.02～0.03 mg/kg)及异丙酚(0.6～0.7 mg/s)静脉推注,2种药物间隔时间为3～5 min,待进入浅睡眠状态、肌肉松驰、睫毛反射消失开始进镜.分别观察术前配合情况、给药时的反应、异丙酚用量、术中反应、清醒时间、术前、术中、术后脉氧饱和度(spO2),心率(HR),呼吸(R),血压(BP)的变化.由操作者评估两组镇静质量.结果:小儿组术前自觉配合率低,给药后2组病人均达到较好的镇静状态.小儿组异丙酚推注过程中躁动妄语率、SpO2一过性下降率、每公斤体质量异丙酚用量、清醒时间[(分别为82.7%,17%,2.4 mg/kg,(17.5±3.2)min)]均明显高于成人组[分别为9%,4%,1.4 mg/kg,(9.5±1.3)min,P<0.01)].用药后2组HR与BP均有不同程度下降,但术后均能迅速恢复,组间比较差异无统计学意义(P>0.05).结论:用异丙酚复合咪达唑仑对小儿实施镇静性上消化道内镜术安全、有效.
목적:탐토이병분복합미체서륜정맥마취재소인상소화도내경술중적응용특점.방법:ASA Ⅰ～Ⅱ급접수무통위경적497례환자분위소인조243례(년령2～14세)급성인조254례(년령18～65세),2조내경검사전균여미체서륜(0.02～0.03 mg/kg)급이병분(0.6～0.7 mg/s)정맥추주,2충약물간격시간위3～5 min,대진입천수면상태、기육송치、첩모반사소실개시진경.분별관찰술전배합정황、급약시적반응、이병분용량、술중반응、청성시간、술전、술중、술후맥양포화도(spO2),심솔(HR),호흡(R),혈압(BP)적변화.유조작자평고량조진정질량.결과:소인조술전자각배합솔저,급약후2조병인균체도교호적진정상태.소인조이병분추주과정중조동망어솔、SpO2일과성하강솔、매공근체질량이병분용량、청성시간[(분별위82.7%,17%,2.4 mg/kg,(17.5±3.2)min)]균명현고우성인조[분별위9%,4%,1.4 mg/kg,(9.5±1.3)min,P<0.01)].용약후2조HR여BP균유불동정도하강,단술후균능신속회복,조간비교차이무통계학의의(P>0.05).결론:용이병분복합미체서륜대소인실시진정성상소화도내경술안전、유효.
Objective To explore the application of propofol combined with midazolam intrave-nous anesthesia in pediatric upper gastrointestinal endoscopy, Methods A total of 497 ASA Ⅰ～Ⅱ patients who received sedative upper gastrointestinal endoscopy were assigned to a children group (2～14 years) and an adults group (18～65 years). The 2 groups were treated with midazolam (0.02～0.03 mg/kg, iv) and propofol (0.6～0.7 mg/s, iv) with an interval of 3～5 minutes. Enterseopy was inserted at light sleep, relaxing muscles, and disappearance of eyelash relaxation. Combining of pro-endoscopy, reaction to intravenous administration, dose of propofol, reaction to en-doscopy, time of returning to consciousness, changes of SpO2, R, HR, and BP, and sedative quali-ty were evaluated. Results Good sedation of the 2 groups after intravenous administration was ob-served. Rate of combining of pro-endoscopy in children was lower (42%) than that in adults (100%). The incidence of restlessness, hyperphasia, temporary decreasing of SpO2, dose of propofol of per kilogram weight, time of returning to consciousness in the children were 82.7%, 17%, 2.4 mg/kg, and (17.5±3.2)min, respectively, which were all higher in the adults [9%,4%,1.4 mg/kg, and (9.5±1.3)min, P<0.01]. HR and BP decreased in the 2 groups, and recovered rapidly after the endoscopy. There was no significant difference between the 2 groups (P>0.05). Conclusion It is safe and effective to use propofol combined with midazolam intravenous sedation anesthesia in pediatric upper gastrointestinal endoscopy.