小剂量异丙酚联合舒芬太尼镇静/镇痛在食管静脉曲张套扎术中的应用

Low-dose propofol combined with sufentanil for sedation/analgesia during endoscopic variceal ligation

目的:探讨小剂量异丙酚联合舒芬太尼用于肝硬化患者内镜下食管静脉曲张套扎术中镇静的安全性和有效性.方法:择期行胃镜下食管静脉曲张套扎术的患者46例,随机分成全身麻醉组(G组)和清醒镇静组(S组).G组给予芬太尼1.5μg/kg,异丙酚1mg/kg,待患者睫毛反射消失,呼之不应时进行操作;S组给予舒芬太尼0.12μg/kg,异丙酚0.25-0.5mg/kg,待患者OAA/S评分达3分时即进行操作.记录患者的心率、血压、脉搏血氧饱和度,同时记录胃镜操作时间、恢复时间、患者和内镜医师满意度评分以及术中、术后不良反应.结果:S组患者血压、脉搏氧饱和度、心率在诱导后无明显变化,而G组的低血压、低氧血症的发生率明显高于S组(45.8%vs4.5%,33.3%vs9.1%,均P<0.05);S组的恢复时间明显短于G组(9.6min±1.4minvs16.5min±1.9min,P<0.05),两组的操作时间,患者和内镜医师满意度评分无明显差异(P>0.05).结论:小剂量异丙酚联合舒芬太尼能安全有效地用于肝硬化患者内镜下食管静脉曲张套扎术,患者具有较好的血流动力学稳定性和较少的呼吸抑制.

AIM：To evaluate the efficacy and safety of combined administration of low-dose propofol and sufentanil for sedation in cirrhotic patients undergoing endoscopic variceal ligation. METHODS：Forty-six patients with cirrhosis scheduled for endoscopic variceal ligation were randomly allocated into general anesthesia group and conscious sedation group.The general anesthesia group was injected intravenously with fentanyl 1.5μg/kg as well as propofol 1 mg/kg,and the endoscope was inserted after the eyelash reflex was lost and the patient wasunresponsive.The conscious sedation was given sufentanil 0.12μg/kg as well as propofol 0.25-0.5 mg/kg,and the endoscope was inserted when an OAA/S score of 3 was achieved.Mean arterial pressure,pulse oxygen,and heart rate were recorded.The duration of endoscopy procedure and recovery time were also recorded. RESULTS：In the conscious sedation group,no significant changes in mean arterial pressure,pulse oxygen and heart rate were noted after induction,whereas patients in the general anesthesia group suffered hypotension and hypoxemia that need intervention after induction（45.8%vs 4.5%,and 33.3%vs 9.1%,both P〈0.05） .The recovery time in the conscious sedation group was shorter than that in the general anesthesia group（9.6 min±1.4 min vs 16.5 min±1.9 min,P〈0.05） . There were no significant differences in the duration of endoscopy procedure and patient/doctor satisfaction between the two groups（all P〉0.05） . CONCLUSION：Low-dose propofol combined with sufentanil can provide better hemodynamic stability,less respiratory depression and shorter recovery time compared with general anesthesia in cirrhotic patients undergoing endoscopic variceal ligation.