“分步给药”在低氧易感患者无痛苦胃镜检查中安全性的探讨

Two-step administration sedation for analgesia gastroscopy in hypoxia-predisposed patients

目的探讨在低氧易感患者无痛苦胃镜检查中采用分步给药的安全性和镇静/镇痛效果。方法接受胃镜检查的180例患者,其中有鼾症、或咳嗽、咳痰症状的患者120例单双号随机入选Ⅰ组(分步给药组)和Ⅱ组(普通组),60例无鼾症、咳嗽、咳痰症状的患者为Ⅲ组(常规给药组),Ⅰ组采用分步给药法,Ⅲ组采用常规给药法对患者实施胃镜检查前的镇静/镇痛术,Ⅱ组则进行普通胃镜检查,分析2种镇静法对SBP、DBP、SpO2、HR、清醒时间、患者反应、患者对检查过程的感受以及是否愿意再次接受检查的影响,评价分步给药法在低氧易感患者无痛苦胃镜检查中的安全性和镇静/镇痛效果。结果Ⅰ组、Ⅲ组检查中SBP、DBP变化无明显差异(均P>0.05),Ⅰ组检查前、中SpO2的变化小于Ⅲ组(均P<0.01);Ⅰ组进镜时咽部受刺激产生的恶心呕吐、流涎、咳嗽、躁动反应多于Ⅲ组(均P<0.01),但较Ⅱ组少(均P<0.01);Ⅰ组对胃镜检查的评价与Ⅲ组无明显差异(P>0.05),与Ⅱ组相比有明显差异(P<0.01)。结论分步给药法是一种适用于低氧易感患者无痛胃镜检查的安全、有效的镇静/镇痛方法。

Objective To evaluate the safety and efficacy of two-step administration sedation in the analgesia gastroscopy for hypoxia-predisposed patients. Methods One hundred and twenty hypoxia-predisposed patients undergoing gastroscopy were divided into 2 groups： group Ⅰ and group Ⅱ, another sixty patients without snore or expectoration were designated as Group Ⅲ. Before gastroscopy group Ⅰ received two-step administration sedation, Group Ⅲ received routine administration sedation, and Group Ⅱ no sedation. SBP, DBP, SpO2, HR were measured; the recovery time, reaction and feeling of patients, the effect of sedation and analgesia were evaluated. Results There was no difference in BP changes （including SBP and DBP） during the gastroscopy between Group Ⅰ and Ⅲ （P〉0.05）, alterations of SpO2 before and during the gastroscopy in Group Ⅰ was less than in Group Ⅲ （P 〈0.01 ）. The degree of pharyngeal malaise including nausea, vomiting, salivating, cough and restlessness in Group Ⅰ was higher than that in Group Ⅲ （P〈0.01）, but was less than that in Group Ⅱ. The degree of upset towards gastroscopy was rated similarly in Group Ⅰ and Group Ⅲ （P〉0.05）. Conclusion The two-step administration sedation method is effective and safe for analgesia gastroscopy in the hypoxia predisposed patients.