异丙酚复合芬太尼或咪唑安定麻醉用于纤维胃镜检查

Comparison of Propofol-fentanyl and Propofol-midazolam Anesthesia for Gastrofiberscopy

目的：比较异丙酚复合芬太尼或咪唑安定麻醉用于纤维胃镜检查的安全性和有效性。 方法：选择150例，ASAⅠ-Ⅱ级行纤维胃镜检查的患者，随机分为3组；P（异丙酚＋生理盐水）组，PM（异丙酚＋咪唑安定）组，PF（异丙酚＋芬太尼）组，均为50例，各组在静推异丙酚前分别静推；生理盐水2ml（P组），咪唑安定0.04mg/kg（PM组），芬太尼 1μg/kg（PF组），待患者睫毛反射消失后插入胃镜，检查过程中连续监测心率（HR），平均动脉压（MAP），脉搏氧饱和度（SPO2），从静推异丙酚开始记录注射部位是否疼痛，睫毛反射消失时间，检查完毕呼之睁眼时间，完全清醒时间（回答正确，行走自如），术中是否知晓（知道胃镜或取镜），术中不适（胃镜时咳嗽，屏气，体动），呼吸抑制（暂停，舌后坠），术后是否恶心呕吐，有无头痛，眩晕，恶梦及自我感觉（舒适，无感觉，不适）。 结果：三组患者均未出现术中知晓，恶心呕吐，亦无恶梦发生，异丙酚的总用量以及睫毛反射消失时间，P组明显多于PM组和PF组（P〈0.05）；每组患者术中平均动脉压，术中最低HR及最低SPO2与术前或术后相比均有明显降低（P〈0.05）；P组的术中最低HR及最低SPO2明显低于PF和PM组（P〈0.05），呼之睁眼时间，PF组明显少于P组和PM组（P〈0.01）；而完全清醒时间，PM组与P组和PF组相比明显延长（P〈0.05）,P组与PF组间无明显差异；注射部位疼痛发生率PF组（10%）明显少于P组（80%）和PM组（74%）（P〈0.01），术中不适（胃镜时咳嗽，体动）的发生率PF组（8%）亦明显少于P组（30%）和PM组（26%）（P〈0.05），所有患者均未发生插管抢救的现象。 结论：异丙酚复合芬太尼或咪唑安定麻醉均能安全有效的完成纤维胃镜的检查，但异丙酚复合芬太尼较之异丙酚复合咪唑安定更适合用于纤维胃镜检查的麻醉。

Objective： To compare efficacy and safety between propofol-fentanyl and propofol-rnidazolam for anesthesia of gastrofiberscopy. Methods： 150 ASA physical status Ⅰ and Ⅱ patents scheduled for elective gastrofiberscopy. Patients were randomized into three groups： P group were given intravenous normal saline 2 ml before propofol（n=5g）： PF group ware given intravenous fentanyl 1μg/kg then propofol （n=5g）; PM group were given intravenous midazolam 0.04mg/kg then ptepefol（n=50）, Total dose of propofol. Extinction time of lash reflex, Heart rate（HR）, Mean arterial pressure（MAP）, Pulse oxygen saturation（SPO2）, Time to open the eye when called, time of full recovery （answering correctly and walking unaided）, Discomfort, Awareness during operation, Selffeeling were recorded. Analysis of date was with SPSS 10.0 P 〈 0.05 was considered significant. Results： No episodes of nausea, vomiting, nightmare or awareness were noted in all patients; Total dose of propofol, and extinction time of lash reflex in P group was significantly more than PM or PF group （P 〈 0.05）, no difference between PM and PF group; MAP, minimum HR and SPO2 during operation were obviously lower than preoperation or postoperagon in each group, minimum HR and SPO2 during operation in P group were significantly lower than P and PM group; Time to eye opening in PF group was significantly less than P or PM group （P 〈 0.05）, no difference between PM and P group; Patiens in PM group reached full recovery obviously slower than P or pF（P 〈 0.05）, no difference between PF and P group; Iocidence of pain on injection in PF group（10%） was obviously lower than PM group（74%） or P group（80%）; Incidence of coughing and moving during operation（8%） in PF group was obviously lower than PM group（26%） or P group （30%）： Degree of comfort was no differce. Conclusion： Gastrofiberscopy can be preformed effectively and safely with propofol-fentanyl or propofol-midazolam, propofol-fentanyl especially fits for gastrofiberscopy compared with propofol-midazlam.