青年人群上消化道内镜下诊治术前镇静特点探讨

Characteristics of sedation for upper gastrointestinal endoscopy in younger adults

目的比较不同年龄人群上消化道内镜下诊治术前镇静时的用药量及镇静效果,探讨在青年人群中实施镇静性上消化道内镜术的镇静特点.方法共266人(18-60岁)接受镇静性上消化道内镜术,分为A组(青年组,n=168,18～35岁)及B组(n=98,36～60岁).术前均给予利多卡因咽喉麻醉及吸氧,内镜术前均给予咪唑安定0.02～0.05mg/kg(Range1.0～1.5mg),异丙酚0.5～2.5mg/kg(Range 40～175 mg),待受检者呼之不能应答,睫毛反射消失、氧饱和度＞95%开始进镜,术中酌情追加异丙酚用量.结果A组(青年组)异丙酚初始剂量及总剂量均显著高于B组(P＜0.001);患者评估两组均有较好的镇静质量及记忆缺失效果,操作者评估A组镇静质量明显低于B组(P＜0.001);两组相比血压的影响差异无显著性(P＞0.05),两组间脉率、氧饱和度差异亦无显著性;两组脉率、血压、氧饱和度的严重不良事件发生率比较差异无显著性(P＞0.05).结论在实施镇静性上消化道内镜术时,青年人群异丙酚用量明显增加.如果适当增加青年人群咪唑安定的剂量,同时消除其紧张焦虑情绪,可望保证镇静质量、更好地诱导麻醉,使内镜操作过程更顺利.

To investigate the efficacy and risks of using midazolam and propofol for sedation during upper gastrointestinal endoscopic procedures in younger adults. 266 outpatients undergoing gastroscopy. patients were in two groups, A group(younger adults group, n=168, age 18~35 yrs), B group(n=98 age 36~60 yrs ), Each group with midazolam 0.02～0.05 mg/kg (Range1.0～1.5 mg) iv plus propofol 0.5～2.5 mg/kg(Range 40～175 mg) iv before the procedure, Heart rate, blood pressure and SpO2 were obtained for each patient and monitored continuously during and after the procedure. All patients received supplemental oxygen during the procedure. A group received more propofol than B group (P <0.001). All patients showed high satisfaction with sedation and anesthesia. According to staff gastroenterologists, the rating of sedation quality was significantly lower in A group vs B group (89.29% vs 97.96% P < 0.05). There were significant change of blood pressure. Clinically important changes in blood pressure were most frequently noted. But the differences between A and B group were not statistically significant. [Conclusions] Under adequate surveillance, midazolam combine propofol can produce safe and effective sedation and anesthesia for gastroscopy. Higher-dose midazolam combine propofol appears more effective in increasing the rating of sedation quality in younger adults.