改良警觉与镇静评分在无痛腔镜诊疗中的应用价值

The practicaility of OAA/S score for painless endoscopy

目的探讨应用警觉与镇静(改良OAA/S)评分指导实施无痛腔镜诊疗的应用价值。方法选择无痛内镜受检者160例,随机分为A、B两组,每组各80例。A组采用分步给药法,1%丙泊酚注射液(1～1.5 mg/kg)分两次以1.5 ml/s静脉推入,两次给药时间间隔30 s。B组采用靶控静脉注入1%丙泊酚注射液,起始靶浓度3 ng/ml。两组均待睫毛反射消失、OAA/S评分为0分时,开始进镜操作。内镜操作中依据OAA/S评分调整浓度。结果通过内镜检查,160例受检者中检出肿瘤92例(57.5%),其中上消化道肿瘤74例(80.4%),下消化道肿瘤15例(16.3%),胰腺癌3例(3.3%)。随着丙泊酚用量的增加,OAA/S评分分值越来越低,当OAA/S评分在0～2分时,患者均可顺利完成内镜检查和治疗。两组间一般资料和基础值的差异无统计学意义(P>0.05),当OAA/S评分为0分时,两组血流动力学较基础值明显降低,两组间用药量差异无统计学意义(P>0.05),达到OAA/S评分0分所需时间两组间差异有统计学意义。结论 OAA/S评分适用于评价无痛内镜诊疗麻醉镇静深度。

Objective To study the application value of alert and calm score（Modified OAA/S score） guiding the diagnosis and treatment of painless endoscopy.Methods 160 subjects selected for painless endoscopy were divided randomly into A and B groups,80 in each.Two-stage administration method was applied for Group A.1% propofol injection（1~1.5 mg/kg） was injected intravenously by twice with the interval of 30 s.1% propofol injection was injected intraveously by target controlled infusion for Group B and the initial target concentration was 3 ng/ml.The endoscopic procedure began when lash reflex dissapeared and OAA/S score reached 0 point.Results 92 cases（57.5%） of tumor were detected in 160 subjects by the endoscopic examination,including 74 cases of upper gastrointestinal tumor（80.4%）,15 cases of lower gastrointestinal tumor（16.3%） and 3 cases of pancreatic cancer（3.3%）.The OAA/S score was lower and lower with the increase of the dosage of propofol.The endoscopic examination and treatment was completed successfully when OAA/S score was from 0 to 2 points.The difference of general information and the basic values between the two groups was no significant statistically When the OAA/S score was 0 point,the hemodynamic values of the two groups decreased significantly compared to the basic values.There is no significant difference of dosage between the two groups.The time when the OAA/S score was 0 point between the two groups was significantly different.Conclusion OAA/S score is practical for evaluating the depth of anesthetic sedation of painless endoscopy.