不同麻醉方案在无痛胃肠镜诊疗中的麻醉效果分析

Analysis of anesthetic effect of different anesthesia regimens in painless gastroenteroscopy

目的探讨不同麻醉方案在无痛胃肠镜诊疗中的麻醉效果。方法选取2019年4~10月首都医科大学宣武医院行无痛胃肠镜检查的患者132例,按照随机数字表法分为3组,每组44例。A组为地佐辛+丙泊酚,B组为舒芬太尼+丙泊酚,C组为咪达唑仑+舒芬太尼+丙泊酚。比较3组麻醉前(T0)、胃镜过喉部(T1)、肠镜开始时(T2)、肠镜过肝曲(T3)、唤醒时(T4)时的心率(heart rate,HR)、SpO2、呼吸频率(respiratory rate,RR)、MAP。记录胃肠镜检查及定向力恢复、日间病房停留时间,丙泊酚总用量,调查患者满意度。记录不良反应,包括术中体动及呼吸抑制、检查后疼痛、恶心呕吐、头晕、嗜睡、视物模糊及总不良反应发生率。结果3组患者T1、T2、T3、T4时的HR、MAP、RR及T1时的SpO2较T0时均显著降低(P<0.05);A组与B组T2、T3、T4时的HR较同组T1时显著降低(P<0.05),而C组T2、T3、T4时的HR较同组T1时无明显变化(P>0.05);A组在T3时的MAP明显高于B组(P<0.017)。C组丙泊酚用量、定向力恢复时间及术中体动发生率低于A组与B组(P<0.017)。C组的离院时间及头晕发生率明显低于A组(P<0.017)。结论咪达唑仑+舒芬太尼+丙泊酚应用于无痛胃肠镜检查中,患者血流动力学更平稳、丙泊酚总用量少、定向力恢复时间快、术中体动发生率低、麻醉效果更满意。

Objective To investigate the anesthetic effects of different anesthesia regimens in painless gastroenteroscopy.Methods A total of 132 patients who underwent painless gastrointestinal examination between April and October 2019 in Xuanwu Hospital,Capital Medical University,were divided into three groups by random number method,44 patients in each group.Dizocine and propofol were used in group A,sufentanil and propofol were used in group B,midazolam,sufentanil,and propofol were used in group C.The heart rate(HR),SpO2,respiratory rate(RR)and mean arterial pressure(MAP)at the time point of pre-anesthesia(T0),the gastroscope passed over the throat(T1),the colonoscopy started(T2),colonoscopy crossed hepatic curvature(T3),waked up(T4)were compared.The time of gastroenteroscopy and directional force recovery,the time of day ward stay,and the total amount of propofol were recorded,and the patients'satisfaction were investigated.Adverse reactions including intraoperative body movement,respiratory depression,pain,nausea and vomiting,dizziness,drowsiness,blurred vision and the incidence of total adverse reactions were recorded.Results HR,MAP and RR at T1,T2,T3,T4 and SpO2 at T1 were less than those at T0(P<0.05),HR at T2,T3 and T4 in group A and group B were less than those of T1(P<0.05),while there was no significant difference in HR at T1,T2,T3 and T4 in group C(P>0.05).At T3,the MAP value of group A was higher than that of group B(P<0.017).The dosage of propofol,directional force recovery time and the incidence of intraoperative body movement in group C were lower than those in group A and group B(P<0.017).In addition,the departure time and the incidence of dizziness in group C were lower than those in group A(P<0.017).Conclusions Midazolam,sufentanil and propofol used in painless gastroenteroscopy have the characteristics of more stable hemodynamics,less total dosage of propofol,faster recovery time of directional force,lower incidence of intraoperative body movement and better anesthetic effect.