丙泊酚配合帕瑞昔布钠在无痛胃肠镜检查和治疗手术麻醉中的应用和分析

Propofol with parecoxib sodium in painless surgery an esthesia management examination and treatment of the application and the analysis

目的探讨丙泊酚复合帕瑞昔布钠用于无痛胃、肠镜麻醉中的可行性及其与现常用方法相比的优缺点。方法随机选择150例行胃镜、肠镜检查和手术治疗的患者,年龄20～70岁,体重42～85kg,ASAI～II级。随机分为3组,每组50例。A组(丙泊酚+芬太尼)静脉推注芬太尼0.05mg后推注丙泊酚;B组(丙泊酚)直接静脉推注丙泊酚;C组(丙泊酚+帕瑞昔布钠)在术前10min静推注帕瑞昔布钠40mg后推注丙泊酚。观察比较患者麻醉前后呼吸循环变化、麻醉镇痛效果、苏醒时间及不良反应等。结果 3组患者均成功完成手术。各组用药后有一定的循环抑制,以B组最明显。A组呼吸抑制发生率显著高于其他组;B组术中镇痛不全和术后腹痛发生率显著高于其他各组;苏醒时间C组快于A组与B组,丙泊酚用量A、C两组均少于B组。结论丙泊酚复合帕瑞昔布钠完全能满足无痛胃、肠镜麻醉需要,其可提供较好的超前镇痛和术后镇痛,较好地解决了单用丙泊酚所致镇痛不全的缺点,并减少了加用芬太尼引起的呼吸抑制。

Objectives To study the feasibility of propofol combined with parecoxib used in the anesthesia of painless gastroscopy and colonoscopy. Explore the advantages and disadvantages compared to the commonly used method. Methods Choose 150 pa- tients, ages： 20 to 70 years old, weight ：42 to 85 kg, ASA：Ⅰ-Ⅱ. RandomLy divided into 3 groups, each one 50 cases. Group A （Propofol ＋ fentanyl）firstly iv fentanyl 0.05 mg then inject the Propofol; Group B （Propofol only） directly injection propofol; Group C （Propofol ＋ parecoxib）inject parecoxib sodium 40 mg 10 minutes earlier before the propofol. Compare the changes of breath and circulation during the anesthesia, narcotic analgesic effects, recovery time and adverse reactions, etc. Results All of the anesthesia were successfully completed. Each group after all have certain inhibition of circulation,especially the group B.The incidence of Respiratory depression in A group was significantly higher than the others;The incidence of intraoperative analgesia and postopera- tive abdominal pain in group B was significantly higher than the others;The group C was the most quick one in awakening; The dosage of propofol ,A and C, two groups were less than B. Conclusion Propofol combined with parecoxib can fully meet the need of the anesthesia for painless gastroscopy and colonoscopy,parecoxib can provide better preemptive analgesia and postoperative analgesia, a better solution to the single propofol induced analgesiathe failure of the shortcomings, and to reduce the addition of fentanyl induced respiratory depression.