异丙酚联合瑞芬太尼应用于无痛胃镜麻醉的临床观察

Study on combining propofol and low-dose remifentani for analgesia gastroscopy

目的：观察异丙酚联合小剂量瑞芬太尼应用于无病胃镜检查麻醉的可行性及不良反应。方法：40例ASA1～2级的胃镜检查患者，随机分为A组（实验组）和B组（对照组），每组20例。A组静脉注射瑞芬太尼0．75μg/kg，B组静脉注射咪唑安定0.02mg／kg，3min后静脉给予异丙酚1～1．5mg／kg，待睫毛反射消失，全身肌肉松弛，稍用力托下颌无反应时开始插胃镜，如有呛咳或体动，酌情追加异丙酚10～30mg。记录检查前、插镜时、检查结束时HR、SBP、DBP、MAP、SPO2以及用药量、苏醒时间和不良反应。结果：与实验组比较，对照组插镜时HR、SBP和MAP均升高（P〈0．05）。对照组用药总量明显大于实验组（P〈0．01），对照组不良反应发生率也高于实验组（P〈0．05）。结论：异丙酚联合小剂量瑞芬太尼麻醉效果好，不良反应少，苏醒迅速，更适用于胃镜检查，值得临床推广应用。

Objective： To investigate the feasibility and side effects of combining propofol and low-dose remifentani for the anesthesia of analgesia endoscopy of stomach. Methods： Forty patients with grade of ASA Ⅰ～Ⅱ undergoing gastroscopy were divided randomly into group A（trial group, n =20） and group B（control group, n = 20）. Patients in group A were infused remifentani 0.75 μg/kg intravenously ; patients in group B were infused midazolam 0.02 mg/kg intravenously, propofol was infused 1- 1.5 mg/kg intravenously after 3 min ; after the disappearance of lash reflex and relaxation of body muscles, then lifted the mandible with reasonable force, if the patient had no reaction, underwent entubation; if the patient coughed or had reaction of movement, added 10～30 mg propofol more. HR,SBP, DBP, MAP,SPO2 were observed and recorded before the examination, at the time of entubation and at the end of the examination. The total dosage of the drugs, time of recovery and side effects were recoded. Results： HR, SBP and MAP ascended at the time of entubation in group B, compared with group A, there was significant difference（P〈0. 05）. The dosage of drug used in group B was obviously more than that in group A （P 〈 0.01 ）. The incidence of side effects in group B was higher than that in group A （P 〈 0.05 ）. Conclusion： Anesthesia by combining propofol and low-dose remifentani has good effect, mild side effects, recovery quickly. It＇s suitable for gastroscopy and worth generaling.