异丙酚复合芬太尼MAC技术在胃镜检查中的应用

Application of MAC by propofol combined with fentanyl in gastroscopy

[目的]探讨以异丙酚复合芬太尼实施监护下麻醉管理（Monitored Anesthesia Care，MAC）技术，应用于胃镜检查中的有效性和安全性。[方法]520例行胃镜检查者随机分为MAC组和对照组（n=260），对照组以2％利多卡因胶浆液行口咽表面麻醉后行胃镜检查。MAC组表麻后以芬太尼1μg／kg静脉注射，继以异丙酚1—2mg／s速度推注，Ramsav镇静分级4～5级后行胃镜检查，术中5—10mg／min速度维持MAC。[结果]MAC组无痛率100％，其中安静入睡213例（82％），轻微肢体活动26例（10％），明显肢体活动影响操作21例（8％），清醒时间短，不良反应少，检查中生命体征平稳。对照组病例则有不同程度的15／咽食道疼痛或不适，不良反应多。[结论]异丙酚复合芬太尼MAC技术应用于胃镜检查，镇痛镇静效果确切，安全。

[ Objective] To investigate the effect and safety of monitored anesthesia care（ MAC）by Propofol combined with Fentanyl in gastroscopy. [ Methods] AU 520 patients attending for gastroscopy were randomly chosen and divided into control group（n = 260）and MAC group（n= 260）. Control group underwent throat local anaesthesia by Lidocaine Hydrochloride Mucilage before normal gas- troscopy. MAC group was given Fentanyl （ 1μg/kg） and Propofol （ 1 - 2 mg/s） intravenously after throat local anaesthesia. If the patients reached class Ⅳ-Ⅴ of Ramsay score, inserted the gastroscope, and maintained with Propofol 5 - 10 mg/min. [Results] In M AC group , painless percentage was 100 %, 213 patients （ 82 % ） was sedately asleep, 26 patients （ 10 % ） had low - grade body movement,21 patient（8% ） had obvious body movement, awake time was short, and the vital signs were stable during gastroscopy. In con- trol group,all patients felt throat ache or discomfort. The incidence of bad resction in controlgroup was higher than that in MAC group. [Conclusion] The application of MAC by Propofol combined with Fentanyl in gastroscopy is safe,comfortable and effective.