无痛内镜在上消化道小探头超声内镜检查中的应用价值

Study on the signficance of application of painless endoscopy in endoscopic ultrasonography of upper digestive tract with small probe

目的探讨无痛内镜在上消化道小探头超声内镜检查中的应用价值。方法将行上消化道小探头超声内镜检查(EMPS)的患者180例纳入研究,按检查操作方法不同随机分为观察组(使用瑞芬太尼联合小剂量丙泊酚达到无痛内镜效果)和对照组(仅行EMPS,不给予麻醉药物或其他无痛措施)。观察两组患者检查前、检查中及检查后即刻患者心率(HR)、平均动脉压(MAP)、血氧饱和度(Sp O2);记录患者不良反应发生情况、用药量、检查用时、达离室标准用时;调查患者检查不适感评分和护理满意度。结果观察组检查全程用时(13.11±7.23 min)明显短于对照组(15.63±9.11 min)(P<0.05);观察组丙泊酚用量为(49.34±14.30)mg,瑞芬太尼用量为(101.72±27.20)μg,对照组未使用麻醉药物。两组患者检查中MAP、HR均有明显变化(P<0.05),但检查后即刻能恢复检查前水平,观察组检查中绝大多数患者Sp O2、HR、MAP在正常范围。观察组达离室标准用时(15.20±4.20 min)与对照组(14.98±3.70 min)无显著差异(P>0.05)。观察组体动、呛咳发生率和总不良反应发生率(5.56%,4.44%,17.78%)均明显低于对照组(68.89%,24.44%,95.56%)(P<0.05);观察组患者对检查中、检查后的不适感评分均低于对照组,满意率(90.00%)高于对照组(77.77%)(P<0.05)。结论瑞芬太尼联合小剂量丙泊酚形成的无痛内镜技术能有效缓解小探头超声内镜检查上消化道疾病中患者不适感,降低不良反应发生率,安全有效,得到患者广泛认可。

Objective To explore the value of application of painless endoscopic ultrasonography in upper gastrointestinal tract. Methods One hundred and eighty patients with small endoscopic ultrasonography（ EMPS） were included in the study. These patients were randomly divided into observation group（ applied with remifentanil combined with low dosage propofol to achieve painless endoscopic effect）. and control group（ only with EMPS,without application of narcotic drug or other painless measures）. Heart rate（ HR）,mean arterial pressure（ MAP） and oxygen saturation（ Sp O2） were recorded before and after the examination. The incidence of adverse reactions,dosage,time for eye opening,the standard time from the room to examination site; survey of discomfort scores of patients and nursing satisfaction. Results The entire available time for check in observation group（ 13. 11 ± 7. 23 min） was significantly shorter than that（ 15. 63 ± 9. 11 min） of control group（ P 〈 0. 05）. The dosages of propofol（ 49. 34 ± 14. 30） mg and remifentanil（ 101. 72 ± 27. 20） μg in patients of observation group,and patients in control group did not use narcotic drug. MAP and HR checked in patients of these 2 groups were significantly changed（ P 〈 0. 05）,but after checking can instantly restore the level before test,Sp O2,HR and MAP checked in majority of patients in observation group were in normal range. The duration for patients in observation group reached and got off the standard room available was（ 15. 20 ± 4. 20） min and that in patients of control group was（ 14. 98 ±3. 70） min,there was no significant difference（ P 〉 0. 05）. The sedentary posture,rate of choking coughing and total incidence of adverse reactions（ 5. 56%,4. 44%,17. 78%） in patients of observation group were significantly lower than those（ 68. 89%,24. 44%,95. 56%） of patients in control group（ P 〈 0. 05）. The scores of discomfort feeling in patients of observation group after examination were lower than those of patients in control group,and the satisfaction rate（ 90. 00%） in observation group was higher than that（ 77. 77%） of control group（ P 〈 0. 05）.Conclusion The combination of remifentanil and low dosage propofol can effectively relieve the discomfort of endoscopy in patients with upper gastrointestinal diseases and reduce the incidence of adverse reactions. It is safe and effective,hence it can widely accept by patients.