自控麻醉在双气囊内镜检查中的应用研究

Research on feasibility and safety of PCA technology in double-balloon endoscopy

目的评价自控镇痛(Patient controlled analgesia,PCA)技术在双气囊内镜(double balloon endoscopy,DBE)检查过程中的安全性和可行性。方法共对120例疑有小肠疾病的患者采用未行麻醉处理(A组)、TCI静脉泵输注丙泊酚(B组)、PCA泵静脉输注瑞芬太尼(C组)的3种检查方法,记录患者的血压、心率、血氧饱和度等生命体征,操作成功率、耐受性评分、离院时间、内镜到达肠段深度及病变检出率,对3种方法在双气囊内镜检查中的可行性和安全性进行评价。结果 A组患者耐受性差,检查成功率只达80%,3组操作时间无显著性差异,但到达肠段深度有显著性差异,B组、C组病变检出率高,但B组患者操作中血氧饱和度较操作前下降,使麻醉风险增加。C组患者操作中生命体征与操作前无明显变化,结束及离院时血压、血氧饱和度稳定,降低了麻醉风险。结论本研究认为PCA技术在双气囊内镜检查中的应用,可满足患者在不同时刻的个体化镇痛需要,提高患者对检查的耐受性及依从性,能与操作者进行交流及配合变换体位,可降低操作风险,提高双气囊内镜的操作成功率,具有良好的安全性和优越性。

Objective To evaluate the feasibility and safety of patient controlled analgesia （PCA） technology in the process of double balloon endoscopy （DBE） inspection. Methods Three inspection methods,non-anaesthesia （Group A）, propofol infusion with TCI vein pump （Group B）, and remifentanil vein infusion with PCA pump （Group C）, were applied for 120 patients with suspected small intestinal diseases. The patients＇ vital signs, such as blood pressure, heart rate, and oxygen saturation of blood, successful operation rate, tolerance grading, leaving time, the depth of endoscopy in the intestine, and detection rate of pathological changes were recorded, and the feasibility and safety of the three methods in double balloon endoscopy （DBE） inspection were evaluated. Results Due to the poor tolerance, the inspection success rate of Group A was only 80%. There was no significant difference in the operation time among the three groups, but the depth in the intestine varied significantly. Detection rates of pathological changes in Group B and Group C were high, but the oxygen saturation of blood during the operation of Group B was lower than that before the operation, which increased the anesthesia risk. There was no significant change in the vital signs of Group C during and after the operation, and the blood pressure and the oxygen saturation of blood were stable when the operation was over and the patient was leaving the hospital, which reduced the anesthesia risk. Conclusion The research believes that the application of PCA technology in the double-balloon endoscopy inspection can meet the various individual analgesic needs of patients in different times, increase the tolerance and compliance of patients to the inspection,help the patients to communicate with operators and change positions correspondently,reduce the operation risk and increase the operation success rate of double balloon endoscopy.The technology features are excellently safety and superior.