两种不同给药方法在无痛胃镜检查中的应用  

The Application of Two Kinds of Anesthetic Technique Used in Gastroscopy

作　　者：李晓玲[1] 杨晓蓉[1] 

机构地区：[1]四川省绵阳市中医医院,四川绵阳621000

出　　处：《中国医学创新》2012年第21期91-92,共2页Medical Innovation of China

摘　　要：目的:探讨两种不同给药方法在无痛胃镜检查中的应用效果和安全性。方法:选择ASAⅠ～Ⅱ级的胃镜检查患者100例,随机分为两组,每组50例。B组于静注前先用2%利多卡因3～4ml表面麻醉,两组均静脉推注咪达唑仑0.01～0.02mg/kg,芬太尼0.2～0.4μg/kg,丙泊酚1～2mg/kg。插镜过程中出现体动酌情追加丙泊酚20～30mg。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、患者苏醒时间,评估麻醉方法的有效性和可行性。结果:胃镜经咽时A组心率、收缩压和平均动脉压均明显高于B组,差异有统计学意义(P<0.05);丙泊酚的总用药量A组明显大于B组(P<0.01);镜检时间、苏醒时间及自动离院时间比较,A组较B组明显延长(P<0.01);两组不良反应发生率差异有统计学意义。结论:采用利多卡因咽喉表面麻醉,再复合丙泊酚及小剂量咪达唑仑、芬太尼静脉麻醉用于胃镜检查,有利于减轻胃镜插管时的不良反应,可维持麻醉的平稳性,是无痛胃镜检查较理想、安全的麻醉方法。Objective： To investigate the clinical effects of different anesthesia methods applying for gastroscopy. Method： One hundred ASA Ⅰ - Ⅱ patients scheduled for gastroscopy were randomly divided into two groups, propofol fentanil group（group A, n=50） and throat surface anaesthetizing propofol fentanil group（group B, n=50）. Sprayed 3-4 ml of 2% lidocaine toward the throat in group B. Patients in both groups were given midazolam 0.01-0.02 mg/kg, fentani] 0.2-0.4μg/kg and propofol 1-2 mg/kg. More propofol was given, 20-30 mg per time, if there were the signs of light anesthesia such as cough and movement. Hemodynamic variables were continuously monitored and recorded before, during and after gastroscopy. At the same time noted the total drug consumption, the recovery time and side effects. Result： In group A, HR, SBP and MAP were significantly higher than those in group B（P〈0.05）, when inserting the gastroseope. The total propofoi consumption in group A was more than that in group B（P〈0.01）, and the recovery time in group A was significantly longer than that in group B（P〈0.01）. The comparison of the two groups showed a significant statistic difference. Conclusion： Propofol combined with small dose of fentanil after surface anaesthesia of throat with 2% lidocaine shows 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.

关 键 词：咽喉表面麻醉 咪达唑仑 芬太尼 丙泊酚 胃镜检查 

分 类 号：R614[医药卫生—麻醉学]