异丙酚在肝硬化患者无痛胃镜中的应用

Clinical utility of propofol for upper gastrointestinal endoscopy in cirrhotic patients

[目的]探讨肝硬化患者无痛胃镜检查过程中应用异丙酚作为镇静剂的安全性和可行性。[方法]肝硬化患者(肝硬化组)和非肝硬化患者(对照组)各20例接受异丙酚镇静下的胃镜检查,观察2组患者检查前后及过程中的生命体征,数字连接试验A(NCT-A)及并发症发生情况。[结果]肝硬化组与对照组无痛胃镜检查时间、异丙酚用量相比均差异无统计学意义(P>0.05),2组患者检查过程中血压、心率、呼吸频率均有不同程度下降,至苏醒后均基本恢复,但2组检查后清醒时间比较差异有统计学意义(P<0.05)。肝硬化组与对照组总并发症率以及低血压、低氧血症和心动过缓发生率比较均差异无统计学意义(P>0.05)。肝硬化组操作前后2次NCT-A检查时间均较对照组明显延长(P<0.05),但2组检查前后NCT-A完成时间差异无统计学意义(P>0.05)。[结论]异丙酚用于肝硬化患者无痛胃镜检查安全,未诱发或加重肝性脑病。

[Objective]To investigate the safety and feasibility of sedation with propofol for upper gas trointestinal endoscopy（UGIE）in cirrhotic patients. [Methods]Twenty cirrhotic patients and 20 control subjects without liver disease received sedative UGIE with propofol. Vital signs,nu：＇nber connection test A （NCT-A）and sedation-related complications were recorded. [Results]There was no difference of the dose of propofol between the two groups（P〈0.05）. In both groups,blood pressure,heart rate and respiratory rat decreased at different degrees after sedation, but all returned to normal after resuscitation. The complica- tion rates were 30% in the cirrhotic group and 25% in the control group,respectively. The rates of hypo- tension,bradycardia and hypoxemia in both groups were not different between the two groups（P〈0.05）. The NCT-A times before and after sedation of the cirrhotic group were both longer than those of control groups（P〈0.05）. However, there were no difference between the NCT-A times before and after sedation of the same group（P〈0.05）. [Conclusion]Sedation with propofol plus fentanyl is safe in cirrhotic patientsduring UGIE,which will not induce or aggravate hepatic encephalopathy.