中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
21期
30-33
,共4页
李红培%李皓%刘俊乐%张宏
李紅培%李皓%劉俊樂%張宏
리홍배%리호%류준악%장굉
麻醉,静脉%胃镜检查%表面麻醉%不良反应
痳醉,靜脈%胃鏡檢查%錶麵痳醉%不良反應
마취,정맥%위경검사%표면마취%불량반응
Anesthesia,intravenous%Gastroscopy%Topical pharyngeal anesthesia%Side effects
目的 观察咽部表面麻醉在中深度镇静麻醉下胃镜检查中的应用价值.方法 选择行无痛胃镜检查150例患者,根据就诊顺序随机分为两组,每组75例.入室后试验组患者予以1％丁卡因喷雾咽喉部3次,以患者出现口咽部麻木感为佳;对照组患者不进行咽喉部喷雾.所有患者静脉推注1.0 mg咪达唑仑,随后静脉滴注芬太尼0.05 mg,药物起效后缓慢静脉推注丙泊酚至中重度镇静(BIS:55 ～ 65)后给予镜检.操作过程中如有体动反应或BIS＞ 70,追加丙泊酚0.3 ～ 0.5 mg/kg.观察各组血压、心率、脉搏血氧饱和度(SpO2)、丙泊酚用量以及不良反应的发生,记录患者的麻醉效果.结果 试验组患者麻醉效果优59例、良15例、差1例,对照组分别为53例、19例、3例,两组比较差异无统计学意义(P＞ 0.05).两组麻醉前、进镜时及退镜后SpO2、心率、平均动脉压比较差异无统计学意义(P＞0.05).两组诱导时间、苏醒时间、丙泊酚用量比较差异无统计学意义(P＞0.05).两组围手术期躁动、呛咳、呼吸抑制的不良事件发生情况比较差异均无统计学意义(P＞0.05);但试验组患者表面麻醉后,咽部不适37例、恶心24例、紧张恐惧49例,显著高于对照组的0,0,12例,差异有统计学意义(P＜0.05).结论 咪达唑仑-芬太尼-丙泊酚中深度镇静麻醉复合咽部表面麻醉不能减轻胃镜检查操作中的不良反应,反而增加术前患者不适感和恶心呕吐,临床应用价值有限.
目的 觀察嚥部錶麵痳醉在中深度鎮靜痳醉下胃鏡檢查中的應用價值.方法 選擇行無痛胃鏡檢查150例患者,根據就診順序隨機分為兩組,每組75例.入室後試驗組患者予以1％丁卡因噴霧嚥喉部3次,以患者齣現口嚥部痳木感為佳;對照組患者不進行嚥喉部噴霧.所有患者靜脈推註1.0 mg咪達唑崙,隨後靜脈滴註芬太尼0.05 mg,藥物起效後緩慢靜脈推註丙泊酚至中重度鎮靜(BIS:55 ～ 65)後給予鏡檢.操作過程中如有體動反應或BIS＞ 70,追加丙泊酚0.3 ～ 0.5 mg/kg.觀察各組血壓、心率、脈搏血氧飽和度(SpO2)、丙泊酚用量以及不良反應的髮生,記錄患者的痳醉效果.結果 試驗組患者痳醉效果優59例、良15例、差1例,對照組分彆為53例、19例、3例,兩組比較差異無統計學意義(P＞ 0.05).兩組痳醉前、進鏡時及退鏡後SpO2、心率、平均動脈壓比較差異無統計學意義(P＞0.05).兩組誘導時間、囌醒時間、丙泊酚用量比較差異無統計學意義(P＞0.05).兩組圍手術期躁動、嗆咳、呼吸抑製的不良事件髮生情況比較差異均無統計學意義(P＞0.05);但試驗組患者錶麵痳醉後,嚥部不適37例、噁心24例、緊張恐懼49例,顯著高于對照組的0,0,12例,差異有統計學意義(P＜0.05).結論 咪達唑崙-芬太尼-丙泊酚中深度鎮靜痳醉複閤嚥部錶麵痳醉不能減輕胃鏡檢查操作中的不良反應,反而增加術前患者不適感和噁心嘔吐,臨床應用價值有限.
목적 관찰인부표면마취재중심도진정마취하위경검사중적응용개치.방법 선택행무통위경검사150례환자,근거취진순서수궤분위량조,매조75례.입실후시험조환자여이1％정잡인분무인후부3차,이환자출현구인부마목감위가;대조조환자불진행인후부분무.소유환자정맥추주1.0 mg미체서륜,수후정맥적주분태니0.05 mg,약물기효후완만정맥추주병박분지중중도진정(BIS:55 ～ 65)후급여경검.조작과정중여유체동반응혹BIS＞ 70,추가병박분0.3 ～ 0.5 mg/kg.관찰각조혈압、심솔、맥박혈양포화도(SpO2)、병박분용량이급불량반응적발생,기록환자적마취효과.결과 시험조환자마취효과우59례、량15례、차1례,대조조분별위53례、19례、3례,량조비교차이무통계학의의(P＞ 0.05).량조마취전、진경시급퇴경후SpO2、심솔、평균동맥압비교차이무통계학의의(P＞0.05).량조유도시간、소성시간、병박분용량비교차이무통계학의의(P＞0.05).량조위수술기조동、창해、호흡억제적불량사건발생정황비교차이균무통계학의의(P＞0.05);단시험조환자표면마취후,인부불괄37례、악심24례、긴장공구49례,현저고우대조조적0,0,12례,차이유통계학의의(P＜0.05).결론 미체서륜-분태니-병박분중심도진정마취복합인부표면마취불능감경위경검사조작중적불량반응,반이증가술전환자불괄감화악심구토,림상응용개치유한.
Objective To explore the value of topical pharyngeal anesthesia combined with deep sedation anesthesia in patients undergoing painless gastrointestinal endoscopy examination.Methods One hundred and fifty patients were randomly divided into test group and control group,each group 75 patients.Before the examination the patients of test group were sprayed throat 1％ tetracaine three times,the patients of control group were not performed throat spray.All patients were given intravenous midazolam 1.0 mg before the examination,then all patients were given intravenous fentanyl 0.05 mg and intravenous injection of propofol when BIS was 55-65,the microscopy was given.If the patients had somatic reaction or BIS ＞ 70,additional propofol 0.3-0.5 mg/kg.The blood pressure (BP),heart rate (HR),venous oxygen saturation (SpO2),the dose of propofol and side effects were observed.Results The anesthetic effects:excellent 59 cases,mild good 15 cases,no good 1 case in test group,excellent 53 cases,mild good 19 cases,no good 3 cases in control group,there was no significant difference (P ＞ 0.05).The level of SpO2,HR,MAP before anesthesia,during operation and after operation between two groups had no significant difference(P ＞ 0.05).The induction time and recovery time of anesthesia,the dose of propofol between two groups had no significant difference (P ＞ 0.05).The rate of restlessness,bucking,respiratory depression between two groups had no significant difference(P ＞ 0.05).In test group,pharyngeal portion unwell 37 cases,nausea 24 cases,tension 49 cases,and in control group was 0,0,12 cases,there was significant difference (P ＜ 0.05).Conclusions The use of deep sedation anesthesia with midazolam-fentanyl-propofol can not reduce the incidence of cough,respiratory depression and other side effects,but can increase the rate of pharyngeal portion unwell and nausea.The clinical value is limited.
