分步给药法在老年人无痛胃镜检查中的应用

Study on two-stage sedation administration method for the elderly in gastroscopic examination

目的探讨分步给药镇静法在老年人胃镜检查中的安全性及镇静、镇痛效果。方法将128例老年患者分为序贯给药组和分步给药组，分别采用序贯给药法和分步给药法，对两组患者实施胃镜检查前镇静；记录镇静前后的平均动脉压（mean arterial pressure，MAP）、脉搏氧饱和度（SpO2）、镇静深度、清醒时间、异丙酚用量、心电图、进镜时咽部不适程度和术后对胃镜检查不适的遗忘程度，评价分步给药法和老年人胃镜检查中的安全性及镇静、镇痛效果。结果用药前后，分步给药组MAP差值为（10．6±1．6）mmHg，序贯给药组（12．4±2．1）mmHg，两组比较差异无统计学意义。分步给药组镇静前后SpO2分别为（98．6±1．1）％和（98．8±1．5）％，无SpO2〈90％者，序贯给药组为（98．8±1．2）％和（95．8±3．2）％，下降（3、0±1．1）％，SpO2〈90％者有6例（9．4％），两组比较差异有统计学意义（P〈0．05）。与序贯给药组比较，分步给药组镇静深度浅、清醒时间短、异丙酚用量少（P〈0．01）；两组检查前、后心电图ST—T均尤明显变化；分步给药组进镜时咽部的不适程度评分高于序贯给药组（P〈0．01）；而两组对胃镜榆查不适的遗忘程度差异无统计学意义。结论分步给药镇静法是适合老年患者进行胃镜检查安全而有效的镇静、镇痛方法。

Objective To explore the safety and the efficacy of the two-stage sedation administration method for the elderly in gastroscopic examination. Methods 128 elderly patients were divided into two groups according to age and body mass index （BMI）, and were given sedation treatment before gastroscopic examination by two-stage administration method（group TSAM, n=64） and continual administration method （group CAM, n= 64） of analgesics respectively. The following major data were recorded ： （ 1 ） mean artery pressure （MAP） ; （2） Blood oxygen saturation （ SpO2 ） ; （3） sedation level;（4） recovery time; （5） the amount of propofol used for sedation; （6） electrocardiogram （ECG） ; （7）the degree of pharyngeal malaise; （8） the oblivion degree of malaise. Results There was no significant difference in MAP alteration between two methods（P〉0.05）. Compared with group CAM, the decreased degree of SpO2 was slighter and no patient＇s SpO2 was lower than 90% in group TSAM （P〈0.05）. Fifty-seven patients in group TSAM fell into sedative state for gastroscopy with OAA/S score 2, while sixty patients in group CAM with OAA/S score 2, which represented a deeper sedation level in group CAM （P〈0.01）. The recovery time was shorter and the amount of propofol used was significantly less in group TSAM than in group CAM（P〈0.01）. During the process of gastroscopic exmaination, ST-T change and arrhythmia in ECG were not seen in either of these two groups. The pharyngeal malaise of patients in group TSAM was more severe than in group CAM （P〈 0.01）. However, there was no difference in the oblivion degree of malaise between two methods（P〉 0.05）. Conclusions The two-stage sedative administration method is safer and more effective for gastroscopic examination for the elderly.