阿芬太尼复合丙泊酚对胃镜检查病人麻醉效果观察

THE EFFICACY OF ANESTHESIA OF COMBINED PROPOFOL WITH ALFENTANIL FOR PATIENTS UNDERGOING GASTROSCOPY

目的在SNAP监测仪监测麻醉深度的条件下,观察阿芬太尼复合丙泊酚对胃镜检查病人麻醉的效果。方法选择ASAⅠ～Ⅱ级自愿接受胃镜检查的病人40例,随机分为对照组(C组)、观察组(A组)两组。C组首次给药时单独给予丙泊酚1.5mg/kg,A组于丙泊酚给药前1min注射阿芬太尼3μg/kg。观察并记录两组给药前、胃镜通过咽喉部时、胃镜抵达十二指肠降部时、检查结束时的SNAP指数(SI)、平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2);比较两组丙泊酚总用量、操作时间、苏醒时间、定向力恢复时间;比较两组术中体动、呼吸抑制及术后并发症发生率。结果胃镜抵达十二指肠降部时,C组SI、MAP、HR、SpO2与A组比较差异均有显著性(t=-3.15～3.67,P<0.05)。检查结束时,C组SI、MAP、HR与A组比较差异有显著性(t=2.09～5.32,P<0.05)。与C组比较,A组病人丙泊酚总用量显著减少(t=5.48,P<0.05),操作时间、苏醒时间、定向力恢复时间明显缩短(t=2.89～7.82,P<0.05)。术中胃镜通过咽喉部时,C组8例病人发生体动,A组仅1例发生体动(χ2=6.89,P<0.05)。结论推荐使用小剂量阿芬太尼复合丙泊酚用于胃镜检查。

Objective To observe the anaesthetic effect of propofol combined with fentanyl on gastroscopy under monitoring the depth of anesthesia by a SNAP monitor.Methods Forty patients(ASA Ⅰ-Ⅱ) voluntarily accepted gastroscopy were selected and evenly randomized to two groups: control group and observation group.For patients in the control,propofol(1.5 mg/kg) alone was given as the first medication;for those in the observation group,alfentanil(3 μg/kg) was injected 1 min before the medication of propofol.SNAP index(SI),mean arterial pressure(MAP),heart rate(HR),and oxygen saturation(SpO2) were observed and recorded before medication,when the gastroscope passing through the throat,reaching the descending duodenum,and upon completion of the examination.A comparison was done between the two groups in terms of the following parameters: the total dosage of propofol used,the time of procedure,of palinesthesia,and of recovery of orientation;the incidence of intraoperative body movement,respiratory depression and postoperative complications.Results When the gastroscope reached the descending duodenum,the differences of SI,MAP,and SpO2 between the two groups were significant(t=-3.15-3.67,P<0.05);Upon completion of the examination,the differences of SI,MAP and HR between the two groups were significant(t=2.09-5.32,P<0.05).Compared with the control group,the dosage of propofol used in the observation group was much less(t=5.48,P<0.05),and the time of examination,of procedure,of palinesthesia,and of recovery of orientation were shorter(t=2.89-7.82,P<0.05).When the gastroscope passed through the throat,body movement was seen in eight patients in the control,and only one in the observation(χ2=6.89,P<0.05).Conclusion It is recommended to use combined propofol with low-dose alfentanil(3 μg/kg) for gastroscopy.