丙泊酚联合咪达唑仑及利多卡因在老年胃镜检查中麻醉效果的比较

Effects of propofol with midazolam verus lidocaine during gastroscopy in elderly patients

目的:本文旨在探讨丙泊酚联合咪达唑仑及利多卡因胶浆两种麻醉方法在老年患者内镜检查中的效果.方法:选择2008-07/2013-07于我院应用丙泊酚联合咪达唑仑麻醉方式行无痛胃镜检查的美国麻醉医师协会(American Society of Anesthesiology,ASA)Ⅱ级患者97例作为实验组,应用传统利多卡因胶浆行无痛胃镜检查患者的ASA-Ⅱ级患者82例作为对照组,两组患者在年龄、体质量、基础血压方面均无统计学差异(P>0.05),具有可比性.分别由专业医护人员记录检查过程患者血压、心率、血氧饱和度及不良反应程度变化.结果:实验组检查中及检查后血压和心率均比对照组低(血压:90.2 mmHg±2.5 mmHg vs131.2 mmHg±3.4 mmHg,心率:70.2次/min±1.5次/min vs 85.0次/min±6.4次/min,P<0.05),其差异具有统计学意义(P<0.05);实验组检查过程中血压及心率先下降,再上升至稳定水平,对照组先上升,再下降至稳定水平,两组组内差异均有统计学意义(P<0.05).血氧饱和度在组间和组内比较均无明显差异(P>0.05).实验组与对照组相比产生不良反应患者数明显减少(χ2=12.991,142.482,55.838,179.000,P<0.05).麻醉苏醒时间与药物消除时间较短(1.51 s±0.17 s,8.21 s±2.32 s).结论:在无痛胃镜技术中使用丙泊酚联合咪达唑仑方式可有效降低患者发生心血管疾病的危险率,并因苏醒迅速、药物消除作用快、舒适度高等优点可广泛应用于临床.

AIM： To compare the effects of propofol with midazolam versus lidocaine during endoscopy in elderly patients. METHODS： Ninety-seven ASA-Ⅱ class patients were used as an experimental group. They were treated with propofol with midazolam for pain- less gastroscopy between July 2008 and July 2013 at our hospital. Eighty-two ASA-Ⅱ level patients who used traditional lidocaine gel pulp in painless gastroscopy were used as a control group. Age, weight, baseline blood pressure be- tween two groups had no significant differences （P 〉 0.05 for all）. Professional medical personnel recorded the changes in blood pressure, heart rate, oxygen saturation and adverse reactions in the examination process.RESULTS： After the painless gastroscopy pro- cedure, blood pressure and heart rate in the experimental group were significantly lower than those in the control group （blood pressure： 90.2 mmHg ± 2.5 mmHg vs 131.2 mmHg ± 3.4 mmHg; heart rate： 70.2 ± 1.5 vs 85.0 ± 6.4, P 〈 0.05）. During the examination process, blood pressure and heart rate dropped initially and then rose to a stable level in the experimental group, while in the control group, blood pres- sure and heart rate initially increased and then decreased to a stable level. The differences were statistically significant （P 〈 0.05） within the two groups. Oxygen saturation between groups and within groups showed no significant differences （P 〉 0.05）. Compared with the control group, adverse reactions in the experimental group were significantly reduced （χ2 = 12.991, 142.482, 55.838, 179.000, P 〈 0.05）. Times to wake up from anesthesia and drug elimination were relatively short in the experimental group （1.51 s ± 0.17 s, 8.21 s ± 2.32 s）. CONCLUSION： Propofol combined with mid- azolam in painless gastroscopy can effectively reduce the risk of cardiovascular diseases in patients and is associated with shorter times to wake up and drug elimination.