镇静术在早期食管癌、胃癌及癌前病变内镜治疗中的应用

Sedation in endoscopic treatment of early esophageal and gastric cancer and precancerous lesion.

目的探讨异丙酚复合小剂量咪达唑仑行镇静术于早期食管癌、胃癌及癌前病变内镜治疗中的应用及安全性.方法 48例早期食管癌、胃癌及癌前病变在内镜下行黏膜切除术及氩离子凝固术患者,ASAⅠ、Ⅱ级,均静脉应用异丙酚复合小剂量咪达唑仑行镇静术.进镜前静脉缓慢注射咪达唑仑0.07 mg/kg,待患者入睡后进镜,先行治疗前病变观察、染色等操作,继之静脉缓慢注射异丙酚1.5～2.0 mg/kg,1 min后即可开始治疗,术中根据治疗需要追加异丙酚0.5～1.0 mg/kg.治疗过程中持续监测平均动脉压(MAP)、心率、脉搏、血氧饱和度(SpO2),并观察患者镇静程度及术中反应(呼吸、咳嗽、屏气、体动反应等).术后记录治疗时间、异丙酚用药量、睁眼时间、清醒时间及患者感受.结果治疗过程中镇静程度评分4～5分43例(90%),呛咳反应3例(6%),体动反应2例(4 %).MAP、心率、SpO2基本平稳,组内比较差异均无显著性(均为P＞0.05).平均治疗时间35 min,平均异丙酚用药量(25±7)ml.均于停药后2～3 min内睁眼,10 min内完全清醒;术后均无不适主诉,对治疗过程无任何记忆.结论异丙酚复合小剂量咪达唑仑行镇静术用于早期食管癌、胃癌及癌前病变的内镜治疗安全有效.

Objective To elucidate the safety of disoprofol combined with small dosage of midazolam in the endoscopic therapy of early esophageal and gastric cancer as well as precancerous lesion. Methods 48 cases with ASA Ⅰ-Ⅱ grade undergoing endoscopic mucosal resection （ EMR ） and argon plasma coagulation （ APC ） accepted sedation by intravenous injection of disoprofol combined with small dosage of midazolam. The patients were given 0.07mg/kg midazolam before endoscopic treatment,and then the patients were treated 1 minute after 1.5-2.0mg/kg disoprofol was intravenously injected. 0.5-1.0mg/kg disoprofol could be added in endoscopic therapy when needed. Mean aortic pressure （MAP） ,heart rate （HR） ,pulse rate and SpO2 were observed, the sedation scores and the response （including respiratory,cough, breathholding and limb movement） were recorded during the endoscopic therapy. After operation, the treatment time, dosage of disoprofol, the time when the eyes opened and the consciousness recovered, and the patients＇ feeling were recorded. Results The sedative scores of 4-5 point was recorded for 43 patients （90%）.There were 3 cases （6%） with cough reaction,and 2 eases （4%） with limb movement. No significant changes were found with MAP, HR and SpO2 （P〉0.05）. The average treatment time was 35 min. The average dosage of disoprofol was （25±7） ml. All of the patients woke in 10 minutes,and opened eyes in 2-3 minutes after the use of disoprofol combined with small dosage of midazolam was ceased. None of the patients had discomfort complain or the memory of endoscopic therapy. Conclusion Disoprofol combined with small dosage of midazolam can produce safe and effective sedation in endoscopic therapy for early esophageal and gastric cancer and precancerous lesion.