CAJ | 학술논문

目的：比较三种复合麻醉方法在胃镜下治疗食管静脉曲张患者时的镇静效果及其对呼吸循环影响。方法选择2011年6月—2012年12月在该院接受麻醉需要的胃镜下行食管静脉曲张治疗的患者90例，单盲随机分为3组，每组30例。 I组先静注芬太尼，接着静注丙泊酚（1~2 mg/kg)；II组先静注芬太尼，接着静注依托咪酯（0.2~0.3 mg/kg)；Ⅲ组静注芬太尼，再静注丙泊酚+依托咪酯混合液（剂量比7：1)。3组患者均给予2%利多卡因5 mL咽部表面麻醉，并给予芬太尼为0.5~1 ug/kg，总量不超过50 ug，待睫毛反射消失后开始进镜。观察术中镇静程度及记忆缺失、苏醒时间；注药前、置镜前、置镜后、苏醒后HR、MAP和脉搏血氧饱和度(SpO2)的变化，术后恶心、呕吐。结果Ⅱ、Ⅲ两组注药前后及检查中血压变化，差异无统计学意义(P>0.05)；I组注药后血压下降约15%~30%，与注药前血压比较，差异有统计学意义(P<0.05)。3组置镜时100%无反应，3组100%术中无体动、呛咳，术后恶心呕吐Ⅱ组有5例(16%)，I组、Ⅲ组无。3组患者对检查过程无记忆。 I组、Ⅲ组所有患者对此次检查治疗满意。Ⅱ组患者因恶心呕吐有10%患者不满意。结论咽部表面麻醉后采用芬太尼+丙泊酚+依托咪酯麻醉对胃镜下食管静脉曲张患者治疗安全、有效、简单易行。
목적：비교삼충복합마취방법재위경하치료식관정맥곡장환자시적진정효과급기대호흡순배영향。방법선택2011년6월—2012년12월재해원접수마취수요적위경하행식관정맥곡장치료적환자90례，단맹수궤분위3조，매조30례。 I조선정주분태니，접착정주병박분（1~2 mg/kg)；II조선정주분태니，접착정주의탁미지（0.2~0.3 mg/kg)；Ⅲ조정주분태니，재정주병박분+의탁미지혼합액（제량비7：1)。3조환자균급여2%리다잡인5 mL인부표면마취，병급여분태니위0.5~1 ug/kg，총량불초과50 ug，대첩모반사소실후개시진경。관찰술중진정정도급기억결실、소성시간；주약전、치경전、치경후、소성후HR、MAP화맥박혈양포화도(SpO2)적변화，술후악심、구토。결과Ⅱ、Ⅲ량조주약전후급검사중혈압변화，차이무통계학의의(P>0.05)；I조주약후혈압하강약15%~30%，여주약전혈압비교，차이유통계학의의(P<0.05)。3조치경시100%무반응，3조100%술중무체동、창해，술후악심구토Ⅱ조유5례(16%)，I조、Ⅲ조무。3조환자대검사과정무기억。 I조、Ⅲ조소유환자대차차검사치료만의。Ⅱ조환자인악심구토유10%환자불만의。결론인부표면마취후채용분태니+병박분+의탁미지마취대위경하식관정맥곡장환자치료안전、유효、간단역행。
Objective To compare the sedative effects of three combined anesthesia methods in the treatment of esophageal varices under gastroscope and the impact of them on the respiration and circulation. Methods 90 patients undergoing the anesthesia for the treatment of esophageal varices under gastroscope were selected and divided into three groups single-blindly and randomly with 30 patients in each. Group I was first given intravenous injection of fentanyl, then propofol (1~2mg/kg);Group II was first giv-en intravenous injection of fentanyl, then etomidate (0.2~0.3mg/kg);Group III was first given intravenous injection of fentanyl, then intravenous injection of propofol and etomidate mixture (dose ratio 7:1). Three groups of patients were given 2% lidocaine 5ml for pharyngeal surface anesthesia, and given fentanyl 0.5~1ug/kg, the total dose did not exceed 50ug, then started to put into the gas-troscope when the eyelash reflex disappeared. The intraoperative degree of sedation, amnesia and postanaesthetic recovery time, the HR, MAP and pulse oxygen saturation (SpO2) before injection of the drugs, before and after putting into the gastroscope and at the postanaesthetic recovery, and the postoperative nausea and vomiting of the patients were observed. Results There were no sta-tistically significant differences in the changes of blood pressure before and after injection of drugs and during the examination be-tween group II and group III (P>0.05). The blood pressure of group I dropped about 15%~30% after injection of drugs, compared with that before the injection, there was a statistically significant difference (P<0.05). 100% of the patients in the three groups had no response when the gastroscope was put into and no body movement and bucking during the operation. 5 cases (16%) in groupⅡwhile no patients in group I and group III had postoperative nausea and vomiting. All the patients in the three groups had no memory of the inspection process. All the patients in group I and group III but in group Ⅱexcept 10% of the patients due to nau-sea and vomiting were satisfied with the inspection and treatment. Conclusion For esophageal varices, the treatment under gastro-scope with fentanyl and propofol and etomidate anesthesia after pharyngeal surface anesthesia is safe, effective, simple and feasi-ble.