静脉全麻在内镜诊疗中的应用.docVIP

静脉全麻在内镜诊疗中的应用 作者：吴静波, 高峰, 袁瑜, 蔡杰衡 【摘要】 目的 研究静脉麻醉药咪唑安定和异丙酚联合应用于内镜检查中的可行性和安全性。方法 ASAⅡ级以下，镇静组胃镜检查者60例、结肠镜检查者36例，同期普通胃镜60例、肠镜36例为对照组；观察在静脉麻醉下生命体征的变化、 镇静效果分级、并发症发生率以及用药总量、检查后清醒时间和离室时间，并与对照组比较。结果 镇静组效果分级在4～5级，对内镜操作无记忆，且在进境、退镜时血压、心率与入室时基本无异，而对照组在进镜时血压、心率有明显升高；两组比较差异有显著性（Plt;0.05）。镇静组恶心呕吐、咳嗽、躁动、咽部不适发生率分别为0、8.3%、10%、0，而对照组分别为38%、1.7%、28%、24%；镇静组清醒时间为(7.86±2.21) min,术毕室内留滞时间为(18.25±3.56) min，而对照组室内留滞时间为(5.12±1.32) min；胃镜总用药量咪唑安定(2±0.25) mg，异丙酚(100±20) mg；肠镜用药量咪唑安定(2±0.25) mg，异丙酚(150±30) mg。结论 静脉麻醉下的内镜检查是操作简单、安全可行的，其术毕室内留滞时间较普通内镜检查稍长, 应由经验丰富的麻醉医师和内镜检查医师合作完成，检查室内应常规配备急救药品和器械，以确保安全。 【关键词】 静脉全麻； 咪唑安定； 异丙酚； 胃镜； 肠镜 　　Abstract:Objective Studying the feasibility and safety of joint application of midazolam and propofol during endoscopic procedures. Methods ASAⅡ class below, 60 cases of gastroscopy and 36 cases of colonscopy in sedative group were administered with intravenous midazolam and propofol, in controlling group, 60 cases of gastroscopy and 30 cases of colonscopy were treated with routine procedures; the changes of blood pressure (BP), heart rate (HR), pulse oxygen saturation(SpO2), the grade of sedation effect, the rate of complications (respiratory depression, blood pressure descendent, nausea, vomiting, cough and restlessness), total dose, the time of waking (eye opening in response, can answer question) the time of leaving room in sedative group were compared with controlling group . Result In sedative group, the grade of sedation effect is in 4 ～5 classes, with no memory of examination, inserting and withdrawing of the endoscopes, the change of blood pressure, and heart rate were slight. But in controlling group, blood pressure and heart rate go up obviously during examination. Comparison of the two groups （Plt;0.05）showed significant statistic difference. The incidence of nausea and vomiting , cough , restlessness, swallow discomfort in sedative group (0, 8.3%,10%, and 0% respectively) were remarkable lower than those in t