瑞芬太尼清醒镇静镇痛技术在上消化道小探头超声内镜中的应用

Application of conscious sedation and analgesia with remifentanil in upper gastrointestinal endoscopic miniprobe ultransonography

目的:探讨瑞芬太尼复合小剂量丙泊酚可唤醒镇静镇痛技术应用于上消化道小探头超声内镜(EMPS)检查的安全性、有效性。方法:将200例行EMPS检查患者随机分为瑞芬太尼复合小剂量丙泊酚组(R组)和对照组(C组),观察两组呼吸循环指标变化、检查时间、误吸、术中不适评分、患者回忆术中不适评分、术者及患者满意度评分,记录R组的用药量、睁眼时间、离室时间。结果:两组均未发生误吸,R组患者术后即刻都能睁眼,离室时间为(15±4.3)min,R组呼吸循环抑制情况轻,易被纠正;与C组相比,R组术中不适评分、患者回忆术中不适评分明显降低,术者及患者满意度明显提高(P<0.05),R组检查时间有缩短趋势,但差异无统计学意义。结论:瑞芬太尼复合小剂量丙泊酚能使患者处于可唤醒状态,可以安全、有效地应用于EMPS检查的镇静麻醉。

Objective： To investigate the safety and efficacy of intravenous anesthesia using remifentanil combined with low-dose propofol in endoscopic miniprobe ultransonography（ EMPS）. Methods： 200 patients undergoing EMPS were randomly divided into two groups（ n = 100） ： the observation group（ Group R） and the control group（ Group C）. The R group received remifentanil combined with low-dose propofol. Hemodynamic and respiratory changes during endoscopic operation, endoscopic examination time, the rates of aspiration or intraoperative discomfort,the score of discomfort in patients＇ memory and the satisfaction of patient＇s and doctor＇s were observed.The dosage of remifentanil and propofol,the waken-up time and the time leaving room were recorded. Results：There was no aspiration in both groups. The eye-opening time was almost 0 and the time leaving room was（ 15 ±4. 3） min in group R. Group R had mild inhabition of respiratory and circulation and it could be managed easily and effectively. The rates of aspiration or intraoperative discomfort in group R was significantly lower than group C,and the patient＇s and doctor＇s satisfaction was significantly higher than group C（ P〈0. 05）. The endoscopic examination time was shorter in group R, but there was no statistical difference between the two groups.Conclusions： Remifentanil combined with low-dose propofol make patients relative conscious during procedure and provide good safety and analgesia effect of sedation anesthesia in endoscopic miniprobe ultransonography.