中华消化内镜杂志
中華消化內鏡雜誌
중화소화내경잡지
CHINESE JOURNAL OF DIGESTIVE ENDOSCOPY
2014年
11期
645-649
,共5页
徐胜浩%岳辉%李清峰%杨文娟%何锋坚%邓三花%彭芊芊%刘素英
徐勝浩%嶽輝%李清峰%楊文娟%何鋒堅%鄧三花%彭芊芊%劉素英
서성호%악휘%리청봉%양문연%하봉견%산삼화%팽천천%류소영
胃镜检查%氧化氮类%二异丙酚%清醒镇静
胃鏡檢查%氧化氮類%二異丙酚%清醒鎮靜
위경검사%양화담류%이이병분%청성진정
Gastroscopy%Nitrogen oxides%Propofol%Conscious sedation
目的:研究笑气化状态的诱导过程并比较笑气清醒镇静镇痛与丙泊酚静脉麻醉用于胃镜检查的安全性及有效性。方法选择2013年4月至2013年10月行胃镜检查患者400例,随机分为笑气组200例和丙泊酚组200例,记录笑气组达到笑气化状态的时间及浓度,2组患者检查前、中、后的收缩压、舒张压、心率、血氧饱和度,及药物起效时间、胃镜操作时间、镇静效果、恢复时间、留院时间、不良反应。检查结束后医生与患者填写调查问卷。结果笑气组达到笑气化状态的平均时间为(3.16±0.65)min,男性与女性无明显差异[(3.16±0.71)比(3.16±0.58)min,t=0.006,P>0.05);达到笑气化状态的平均笑气浓度为(43.68±5.05)%,男性明显高于女性[(45.30±4.99)%比(41.46±4.30)%,t=3.042,P<0.05]。与检查前比较,丙泊酚组检查中的收缩压、舒张压、心率、血氧饱和度均明显降低(P<0.05),而笑气组检查中的收缩压、舒张压、心率均明显升高(P<0.05)。丙泊酚组的起效时间及操作时间比笑气组短(P<0.05),镇静效果比笑气组更深(P<0.05),但笑气组的恢复时间、留院时间均比丙泊酚组明显减少(P<0.05)。检查中丙泊酚组部分患者出现低氧血症、低血压、心率过缓等不良反应,而笑气组主要不良反应为恶心、干呕等咽部刺激反应。调查问卷结果显示:笑气组的医师满意度、患者满意度、患者愿意再次接受检查的比例均低于丙泊酚组(86±3.7比96±2.6,87±2.8比98±1.2,87%比99%,P<0.05)。结论笑气清醒镇静镇痛及丙泊酚静脉麻醉用于胃镜检查均是有效的,但前者对心肺功能影响更小更安全。准确识别笑气化状态是笑气清醒镇静镇痛成功实施的关键。重视影响笑气清醒镇静镇痛技术安全性及有效性的9个因素,对于优化笑气清醒镇静镇痛过程有一定的指导意义。
目的:研究笑氣化狀態的誘導過程併比較笑氣清醒鎮靜鎮痛與丙泊酚靜脈痳醉用于胃鏡檢查的安全性及有效性。方法選擇2013年4月至2013年10月行胃鏡檢查患者400例,隨機分為笑氣組200例和丙泊酚組200例,記錄笑氣組達到笑氣化狀態的時間及濃度,2組患者檢查前、中、後的收縮壓、舒張壓、心率、血氧飽和度,及藥物起效時間、胃鏡操作時間、鎮靜效果、恢複時間、留院時間、不良反應。檢查結束後醫生與患者填寫調查問捲。結果笑氣組達到笑氣化狀態的平均時間為(3.16±0.65)min,男性與女性無明顯差異[(3.16±0.71)比(3.16±0.58)min,t=0.006,P>0.05);達到笑氣化狀態的平均笑氣濃度為(43.68±5.05)%,男性明顯高于女性[(45.30±4.99)%比(41.46±4.30)%,t=3.042,P<0.05]。與檢查前比較,丙泊酚組檢查中的收縮壓、舒張壓、心率、血氧飽和度均明顯降低(P<0.05),而笑氣組檢查中的收縮壓、舒張壓、心率均明顯升高(P<0.05)。丙泊酚組的起效時間及操作時間比笑氣組短(P<0.05),鎮靜效果比笑氣組更深(P<0.05),但笑氣組的恢複時間、留院時間均比丙泊酚組明顯減少(P<0.05)。檢查中丙泊酚組部分患者齣現低氧血癥、低血壓、心率過緩等不良反應,而笑氣組主要不良反應為噁心、榦嘔等嚥部刺激反應。調查問捲結果顯示:笑氣組的醫師滿意度、患者滿意度、患者願意再次接受檢查的比例均低于丙泊酚組(86±3.7比96±2.6,87±2.8比98±1.2,87%比99%,P<0.05)。結論笑氣清醒鎮靜鎮痛及丙泊酚靜脈痳醉用于胃鏡檢查均是有效的,但前者對心肺功能影響更小更安全。準確識彆笑氣化狀態是笑氣清醒鎮靜鎮痛成功實施的關鍵。重視影響笑氣清醒鎮靜鎮痛技術安全性及有效性的9箇因素,對于優化笑氣清醒鎮靜鎮痛過程有一定的指導意義。
목적:연구소기화상태적유도과정병비교소기청성진정진통여병박분정맥마취용우위경검사적안전성급유효성。방법선택2013년4월지2013년10월행위경검사환자400례,수궤분위소기조200례화병박분조200례,기록소기조체도소기화상태적시간급농도,2조환자검사전、중、후적수축압、서장압、심솔、혈양포화도,급약물기효시간、위경조작시간、진정효과、회복시간、류원시간、불량반응。검사결속후의생여환자전사조사문권。결과소기조체도소기화상태적평균시간위(3.16±0.65)min,남성여녀성무명현차이[(3.16±0.71)비(3.16±0.58)min,t=0.006,P>0.05);체도소기화상태적평균소기농도위(43.68±5.05)%,남성명현고우녀성[(45.30±4.99)%비(41.46±4.30)%,t=3.042,P<0.05]。여검사전비교,병박분조검사중적수축압、서장압、심솔、혈양포화도균명현강저(P<0.05),이소기조검사중적수축압、서장압、심솔균명현승고(P<0.05)。병박분조적기효시간급조작시간비소기조단(P<0.05),진정효과비소기조경심(P<0.05),단소기조적회복시간、류원시간균비병박분조명현감소(P<0.05)。검사중병박분조부분환자출현저양혈증、저혈압、심솔과완등불량반응,이소기조주요불량반응위악심、간구등인부자격반응。조사문권결과현시:소기조적의사만의도、환자만의도、환자원의재차접수검사적비례균저우병박분조(86±3.7비96±2.6,87±2.8비98±1.2,87%비99%,P<0.05)。결론소기청성진정진통급병박분정맥마취용우위경검사균시유효적,단전자대심폐공능영향경소경안전。준학식별소기화상태시소기청성진정진통성공실시적관건。중시영향소기청성진정진통기술안전성급유효성적9개인소,대우우화소기청성진정진통과정유일정적지도의의。
Objective To study the induction of nitrous oxide(N2 O)and to compare safety and effec-tiveness of conscious sedation by nitrous oxide inhalation and intravenous sedation with propofol for upper gas-trointestinal(UGI)endoscopy.Methods A total of 400 patients undergoing UGI endoscopy in our hospital from April 2013 to October 2013 were randomly assigned to two groups,N2 O inhalation group(n=200)and in-travenous propofol group(n=200).The systolic pressures,diastolic pressures,heart rates and oxygen satura-tion,onset time,procedure duration,degree of sedation,recovery time,length of hospital stay,complica-tions,satisfaction ratings of doctors and patients,and the number of patients willing to accept the examination again were analyzed.Results The mean time of ideal anesthesia state for N2 O was (3. 16 ±0. 65 )min and there was no difference between the male and female(3. 16 ±0. 71)min vs.(3. 16 ±0. 58)min,t=0. 006,P>0. 05).The mean concentration was (43. 68 ±5. 05 )%,which was higher in male than that in female [(45. 3 ±4. 99)% vs.(41. 46 ±4. 30)%,t=3. 042,P<0. 05].Compared with before,the systolic pres- <br> sures,diastolic pressures,heart rates and oxygen saturation of patients in the propofol group significantly re-duced during the procedure(P<0. 05),while the same measurements excluding oxygen saturation for those in the N2 O group significantly increased(P<0. 05 ).Compared with the propofol group,patients inhaling N2 O had significantly shorter recovery and hospital stay time,but a longer onset time and procedure duration(P<0. 05 ).Complications that occurred in some patients of propofol group included hyoxemia,hypotension,brady-cardia,while the major complication in the N2 O group was nausea.The satisfaction ratings of doctors or pa-tients and the number of patients willing to accept the examination again in N2 O group were smaller than those in propofol group(86 ±3. 7 vs.96 ±2. 6,87 ±2. 8 vs.98 ±1. 2,87%vs.99%,P<0. 05).Conclusion Both conscious sedation by N2 O inhalation and intravenous sedation with propofol are effective for diagnostic UGI en-doscopy,but the safety of the former is superior to the latter.The key to complete the conscious sedation by ni-trous oxide inhalation is to accurately identify the ideal anesthesia state of N2 O.It is significant to pay attention to the nine factors concerning safe and effective sedation during operation.