麻醉下胃肠镜联合检查不同时序的效果

Nursing of patients with orderly gastroscopy andcolonoscopy combined examination under anaesthesia

目的探讨使用丙泊酚同时进行麻醉胃肠镜检查的先后顺序比较及护理临床体会。方法选择同时需要进行无痛胃肠镜检查的患者432例，采取随机分组的方法分为实验组与对照组。实验组患者217例检查顺序为先做胃镜后做肠镜；对照组患者215例检查顺序为先做肠镜后做胃镜。由麻醉医师缓慢静脉注射丙泊酚1.5～2.0mg/kg，待患者睫毛反射消失后即行胃或肠镜检查，检查过程酌情追加丙泊酚用量。观察两组患者丙泊酚用量、检查后呼之睁眼的时间，全程监测血压（BP）、心率（HR）、脉搏血氧饱和度（SpO2）、呼吸频率（R）及不良反应、并发症，若血压下降30%静脉注射麻黄碱5～10mg，心率下降至≤46次/min静脉注射阿托品0.2～0.5mg，血氧饱和度下降时加大氧流量并抬高下颌。结果432例患者均顺利完成胃肠镜检查。其中A组患者丙泊酚的平均用量（275±20）mg，B组患者丙泊酚的平均用量（385±30）mg。两组比较差异有统计学意义（P＜0.05）。检查后呼之睁眼的时间：实验组全部受检患者拔镜后呼之睁眼，对照组患者呼之睁眼时间为（1.7±0.9）min。两组比较差异有统计学意义（P＜0.05）。全程监测BP、HR、SpO2、R及其他不良反应及并发症的比较差异无统计学意义（P＞0.05）。结论选用丙泊酚静脉全麻实施无痛胃肠镜检查时，先检查胃镜后检查肠镜可以减少丙泊酚的用量，苏醒时间快，降低麻醉风险性。胃镜着重呼吸管理，肠镜注意循环调整，及时有效对症处理，麻醉下行胃肠镜检查是平稳而安全的。护理支持在心电监护、供氧、建立静脉通路、镇静观察等至关重要。

Objective To compare the different order selection in gastroscopy and colonoscopy combined examination under anaesthesia with propofol and summarize the clinical nursing experience. Methods 432 patients received painless gastrescopy and colonoscopy combined examination under anaesthesia were divided randomly into two groups, experimental group of 217 cases of patients received gastroscopy examination earlier than colonescopy examination. On the contrary, control group of 215 cases of patients received colonescopy examination prior to gastroscopy examination. All of the patients were injected with 1.5 - 2.0 mg/kg propofol ai a slow speed by anaesthetists. After patients＇ eyelash reflex disappeared, the examination of gastrointestinal endoscopy began. The dosage of the propofol increased according to patients＇ situation during the examination. The indicators including dosage of the propofol, analepsia time, blood pressure, heart rates, pulse oxygen saturation, respiration, adverse reactions and complications were observed and compared between two groups. Results 432 patients completed the examination of the gastrointestinal endoscopy successfully. There was significant difference in the average dosage of propofol, experimental group was （ 275 ± 20 ） mg and control group was （ 385 ± 30 ） mg respectively. In addition, the average of analepsia time in experimental group was shorter than control group. However, the rest of indicators were no significant differences between two groups. The results showed that experimental group was better than control group. Conclusions If the examination of gastroscopy was carried out earlier than eolonoscopy,there are many benefits such as less dosage of propofol, shorter analepsia time and less risks of anesthesia. Nursing interventions in ECG monitoring, oxygen and establish intravenous access, sedation, and other critical observation are very important during examination of gastrointestinal endoscopy under anaesthesia with propofol.