胃镜检查中不同镇静与麻醉方案的比较

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摘要目的：探讨胃镜检查时不同镇静、麻醉方案的效果及安全性。方法：选取2016年4月至2016年12月温州医科大学附属黄岩医院收治的240例无痛胃镜检查患者，随机分为3组：丙泊酚联合舒芬太尼组（PS组，n=80）、丙泊酚联合利多卡因喷剂组（PL组，n=80）及舒芬太尼组（S组，n=80），分别记录患者麻醉前（T0）、胃镜检查入镜前（T1）、胃镜过咽喉部（T2）和胃镜检查结束后5 min（T3）时的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）及丙泊酚的用量，观察患者术中体动、咽反射等反应，记录患者意识恢复时间及观察术后有无头晕等不良反应。结果：PL组较PS组丙泊酚用量显著减少（P＜0.01）。与PS组比较，PL组术中体动发生率低（P＜0.05），PL组、S组咽反射发生率低（P＜0.05），S组心动过缓和低血压发生率低（P＜0.05），PL组术后定向力恢复时间更短（P＜0.01）。与T0期比较，PS组各期MAP降低（P＜0.05），PL组T2期MAP降低（P＜0.05）。3组间比较，S组T1期MAP水平更高（P＜0.05）。在T2期和T3期，MAP水平随着PS组、PL组、S组逐渐升高（P＜0.05）。S组T2期HR较T0、T1期升高（P＜0.05）。结论：在无痛胃镜麻醉中，丙泊酚联合利多卡因喷剂、单独舒芬太尼镇痛镇静安全有效。

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	郭建桃
	叶芊芊
	叶克平
	叶琦刚
	王文伟
	林函

关键词 ：胃镜检查, 利多卡因, 二异丙酚, 舒芬太尼

Abstract：Objective: To assess the advantages and security of three different anesthesia protocols including propofol-sufentanil, propofol-lidocaine aerosol and sufentanil in the outpatient’s gastroscopy procedure. Methods: A total of 240 patients scheduled for gastroscopic examination in Huangyan Hospital Affiliated to Wenzhou Medical University from April 2016 to December 2016 were prospectively randomized into propofol-sufentanil group (PS group), propofol-lidocaine aerosol group (PL group) and sufentanil group (S group). The vital signs (HR, MAP, SpO2) in each group were recorded before anesthesia (T0), before intubation (T1), immediately after intubation (T2) and 5 min after completion of the gastroscopy procedure (T3). The consumption of propofol, the recovery time and adverse effects like body movement, gag reflex, and dizziness were recorded. Results: The dosage of propofol in group PL was significantly lower than in PS group (P<0.01). Compared with PS group, the incidence of body movement in PL group was significantly lower (P<0.05), and the incidence of pharyngeal reflex in PL group and S group was significantly lower (P<0.05). The incidence of tachycardia and hypotension in S group was significantly lower compared with PS group (P<0.05). The recovery time of PL group after the procedure was significantly shorter compared with PS group (P<0.01). Compared with MAP at T0, MAP at T1, T2 and T3 in PS group was lowered (P<0.05) and MAP at T2 in PL group was lowered. Among all the three groups, the MAP level at T1 in S group was highest (P<0.05). At T2 and T3, the level of MAP gradually increased with PS group, PL group and S group (P<0.05). Compared with HR at T0 and T1, HR was increased at T2 in S group (P<0.05). Conclusion: Administration of propofol-lidocaine aerosol and sufentanil in sedation and analgesia can be a feasible anesthesia scheme due to its safety and effectiveness.

Key words： gastroscopy lidocaine propofol sufentanil

通讯作者: 林函，主任医师，Email:nanlinhannansh@qq.com。

作者简介: 郭建桃（1977-），女，浙江台州人，副主任医师，在职硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I8/591

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