无痛胃镜110例临床研究

Clinic study of anaesthetic gastroscopy with 110 cases

目的：探讨丙泊酚复合芬太尼麻醉进行无痛胃镜检查的可行性、安全性和副反应。方法：110例无痛胃镜检查患者为Ⅰ组，配对的110例常规胃镜检查患者为Ⅱ组。Ⅰ组经静脉缓慢推注芬太尼0．5～1μg／kg和丙泊酚1．5—2mg／kg，直至睫毛反射消失后，插入胃镜检查。Ⅱ组进行常规胃镜检查。比较两组并发症的发生率、生命体征（血压、心率、血氧饱和度）的变化情况，以及术后感受。结果：Ⅰ组110例患者均顺利完成检查，在检查中心率和血压有下降趋势（P〈0．05），105例患者（95％）愿意再次接受检查，明显高于Ⅱ组的45例（41％）；检查中两组血氧饱和度均有下降，Ⅰ组高于Ⅱ组（P〈0．05）；Ⅱ组有7例（6％）由于无法忍受而放弃，26例患者（24％）拒绝再次接受检查。结论：丙泊酚复合小剂量芬大尼用于无痛胃镜检查是安全、有效、可行的，具有镇静效果好、清醒快、恢复快、患者满意度高的优点，且未见明显副反应，值得临床推广应用。

Objective To investigate the feasibility, safety and side - effects of endoscopic examinations or treatments under anaesthesia with propofol and fentanyl. Methods 110 patients received anaesthetic gastroscopy by intravenous fentanyl （0. 5 - 1 μg/kg） and propofol （1. 5 - 2mg/kg）, while 110 counterpart patients received routine gastroscopy with only topical pharyngeal anesthesia. The clinical data were collected from both groups for the comparison of complications, vital signs （blood pressure , heart rate, blood oxygen saturation） and post -gastroscopy feeling between two groups. Results 110 patients of anaesthetic gastroscopy were completed successfully without any uncomfortable recollections, and their heart rate and blood pressure declined with significant level. However, all symptoms of tachycardia and hypotension were slight and transient and did not need special treatment. The blood oxygen saturation of all patients dechned in both groups, but compared with routine gastroscopy, anaesthetic gastroscopy had obviously less hypoxemia （ P 〈 0. 05）, and much better post - gastroscopy feeling （ P 〈 0. 05）. Conclusion The side - effects are slight and transient during endo- scopic examinations or treatments under anaesthesia with propofol and fentanyl, and the anaesthetic gastroscopy are proved to be safe and feasible.