健忘镇痛麻醉在无痛胃肠镜诊疗中的应用

Application of analgesic and amnestic anesthesia during painless digestive endoscopy

目的探讨健忘镇痛麻醉用于胃肠镜检查的可行性。方法251例患者随机分成两组，A组：健忘镇痛麻醉组：静脉推注咪达唑仑1~1.5 mg，氟哌利多1 mg，芬太尼0.075~0.15 mg，丙泊酚20~30 mg，患者呈浅睡状态后开始置入胃肠镜。术中根据患者反应如肢动和皱眉追加芬太尼0.05 mg或丙泊酚10-20 mg。B组：芬太尼丙泊酚静脉麻醉组：静注芬太尼0.05 mg后缓慢推注丙泊酚1.5-2 mg/kg。观察两组患者在检查过程中生命体征包括血压、心率、呼吸、血氧饱和度的变化，对刺激的耐受性、不良反应。记录患者清醒时间、离院时间。结果A组丙泊酚用量明显少于B组[（33.73±15.79）mg vs（93.26±20.24）mg，P〈0.01]，芬太尼用量明显多于B组[（0.13±0.04）mg vs（0.07±0.03）mg，P〈0.01]。清醒时间[（1.35±0.91）min vs（5.28±3.29）min，P〈0.01]和离院时间[（22.72±5.06）min vs（24.02±3.67）min，P〈0.05]A组明显短于B组。术后不良反应发生率A组明显少于B组。结论健忘镇痛麻醉用于胃肠镜检查可控性好，不良反应少，进一步提高了麻醉安全性。

Objective To research the feasibility of analgesic and amnestic anesthesia during painless digestive endoscopy. Methods 251 cases who need endoscopic examinations and treatments were divided into two groups ： group A（ 126 cases） ：midazolam 1 -1.5 mg,droperidol 1 mg,fentanyl O. 075-0. 15 mg,propofol 20 -30 mg;group B（control, 125cases）：fentanyl O. 05 mg, propofol 1.5 -2 mg/kg. Result The dosage of fentanyl in group A was more than that in group B and propofol was less than that in group B. A uaking time of group A was shorter than group B and side effects was less than group B. Conclusion Analgesic and amnestic anesthesia had a good controllability, less side effects and proved to be safe.