异丙酚静脉复合麻醉在老年人胃肠镜联合检查中的应用

Applications of intravenous balanced propofol sedation with fentanyl in elderly patients during combined gastroscopy and colonoscopy procedures

目的评价异丙酚合并芬太尼静脉麻醉在老年患者胃肠镜联合检查中的效果及安全性。方法回顾分析326例采用静脉麻醉下胃肠镜联合检查（联合检查组）老年患者的临床资料，与同期接受静脉麻醉下胃镜（胃镜组）或结肠镜检查（结肠镜组）的老年患者进行对照，比较各组血压、心率、血氧饱和度（SpO2）变化情况以及不良反应发生情况。结果异丙酚平均用量分别为联合检查组（100．4±38．5）mg、胃镜组（130．4±50．5）mg、结肠镜组（170．3±60．3）mg，所有患者均能达到胃肠镜检查的满意镇静程度，无因麻醉并发症终止胃肠镜检查者；心率、血压变化及心血管事件发生率各组间比较，差异无统计学意义（P〉0．05）；呼吸事件发生率分别为9例（3．1％）、6例（2．3％）和13例（4．0％），差异亦无统计学意义（P〉0．05）。结论在严格控制适应证、术中严密监测的条件下，应用异丙酚静脉复合麻醉对于老年患者胃肠镜联合检查是安全、有效的。

Objective To evaluate the safety of intrvenous balanced propofol sedation with fentanyl in elderly patients during combined gastroscopy and colonoscopy procedures. Methods Totally 877 elderly patients aged （76.4±8.5） years received intravenous propofol and fentanyl sedation during gastroscopy or/and colonoscopy procedures were assigned to groups： 294 cases with only gastroscopy, 257 cases with only colonoscopy and 326 cases with combined gastroscopy and colonoscopy. 50 g Fentanyl and 0.5-1.0 mg/kg propofol were intravenously administered in the patients. The peripheral oxygen saturation, arterial pressure and heart rate were monitored and recorded during procedures. Results There were no procedure-related perforations and sedation- associated severe complications and mortalities, and no one need stop endoscopy procedures in all the patients. The average dosage of propofol in combined, gastroscopy and colonoscopy groups were （100.4±38.5） mg, （130.4±50.5）mg and （170.3±60.3）mg, respectively. There were no significant differences in heart rate, arterial pressure and rate of cardiovascular events among groups （P〉0.05）. The rate of respiration events in the above groups were 9 cases（3.1%）, 6 cases（2.3%） and 13 cases（4.0%）, respectively （P〉0.05）. Decrease of peripheral oxygen saturation was mainly induced by the aspiration of oral secretions and snoring. Conclusions Intravenous balanced propofol sedation provides safe and effective sedation in the elderly undergoing combined gastroscopy and colonoseopy.