两种不同麻醉方法在胃镜检查中的应用效果
胃镜,,咽喉表面麻醉；,异丙酚；,芬太尼；,胃镜,1资料与方法,2结果,3讨论,参考文献:
(新疆医科大学第一附属医院麻醉科，新疆乌鲁木齐830054)摘要: 目的: 探讨两种不同麻醉方法在胃镜检查术中的应用效果。方法: 心功能ASAⅠ～Ⅱ级的胃镜检查患者30例，随机均分为2组：Ⅰ组应用异丙酚复合芬太尼，Ⅱ组利多卡因咽喉表面麻醉后再应用异丙酚复合芬太尼。同时开放静脉，2组均静注芬太尼1 μg/kg，3 min后静注异丙酚1 mg/kg,插镜过程中出现体动酌情追加异丙酚10～30 mg。观察记录胃镜检查过程中的血液动力学变化、不良反应、用药剂量及胃镜操作时间、病人苏醒时间，评估麻醉方法的有效性和可行性。结果: 插镜时Ⅰ组心率、收缩压和平均动脉压均明显高于Ⅱ组，差异有统计学意义(P<0.05～0.01),异丙酚的总用药量Ⅰ组明显大于Ⅱ组(P<0.01)，苏醒时间Ⅰ组明显较Ⅱ组延长(P<0.01)。2组不良反应发生率差异有统计学意义。结论: 采用2%利多卡因咽喉表面麻醉，再复合异丙酚及小剂量芬太尼静脉麻醉有利于减轻胃镜插镜时的不良反应，可维持麻醉的平稳性，是无痛胃镜检查的最为理想、安全的麻醉方法。
关键词: 咽喉表面麻醉； 异丙酚； 芬太尼； 胃镜
The application of two kinds of anesthetic technique used in gastroscopy
SUN Yidan, ZHAO Hong
(Department of Anesthesiology, First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, China )
Abstract: Objective: To investigate the clinical effects of different anesthesia methods applying for gastroscopy. Methods: Thirty ASA Ⅰ～Ⅱ patients scheduled for gastroscopy were randomly divided into 2 groups: propofol fentanil group (group I, n=15) and throat surface anaesthetizing propofol fentanil group (group Ⅱ, n=15). Sprayed 2 ml of 2% lidocaine toward the throat in group II. At the same time had a vein open. Patients in both groups were given fentanil 1 μg/kg intravenously. Three minutes later injected propofol 1~1.5 mg/kg. If the patients reached class Ⅳ of Ramsay score, inserted the gastroscope. More propofol was given, 10～30 mg at a time, if there were the signs of light anesthesia such as cough and movement. Hemodynamic variables, such as HR, SBP, DBP, MAP, SpO2, were continuously monitored and recorded before, during and after gastroscopy. At the same time noted the total drug consumption,the recovery time and the ill effects. Results: In group II HR, SBP and MAP were significantly higher than that in group Ⅰ while inserting the gastroscope. The total propofol consumption, and the recovery time in grope Ⅰ was significantly larger than that in group Ⅱ. The incidence of side effects in group I was also higher. Conclusion: Propofol combined with small dose of fentanil after surface anaesthesia of throat with 2% lidocaine showed higher anesthesia quality, less side effects, and more rapid and smooth recovery. In current this technique is an effective, safe anesthesia method for painless gastroscopy, and worth popularizing and applying clinically. ......
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