电子胃镜检查中异丙酚与咪唑安定联合应用的临床监护

近年我院采用异丙酚与咪唑安定联合应用于胃镜检查与治疗患者,收到满意效果。我们对应用镇静、镇痛技术实施检查与治疗过程中,患者呼吸循环情况进行了观察,报道如下。

镇静无痛苦胃镜检查中两种联合用药的效果评价及安全性研究

目的 探讨联合应用芬太尼 异丙酚与咪唑安定 异丙酚在胃镜检查中的镇静镇痛效果和安全性。方法 将胃镜检查者随机分为芬太尼 异丙酚组 (Ⅰ组 ) ,咪唑安定 异丙酚组 (Ⅱ组 )和对照组 (常规胃镜组 ,Ⅲ组 )。观察记录各组受检者术中的反应、胃镜操作时间、麻醉药物作用时间 ,检查前中后BP、HR、SPO2 和SDNN(正常R R间期标准差 ) ,及术后问卷调查。结果 Ⅰ、Ⅱ组术中不适反应少、胃镜操作时间短、10 0 %舒适无痛苦 (P <0 .0 5 )。Ⅲ组术中BP、HR显著增高 ,SDNN显著下降 (P <0 .0 1) ,而Ⅰ、Ⅱ组术中BP、HR及SDNN均一过性轻度下降 (P <0 .0 1)。与Ⅱ组比较Ⅰ组药物起效更快、苏醒及清醒时间更短、术中不适反应更少 (P <0 .0 1)。结论 联合应用芬太尼 异丙酚及咪唑安定 异丙酚在镇静无痛苦胃镜检查中是舒适安全的 ,芬太尼 异丙酚联用起效更快、恢复时间更短、不适反应更少。

无痛胃镜技术在拉萨地区的应用

目的探讨应用异丙酚加安定静脉推注在无痛胃镜中镇痛镇静效果。方法常规检测病人血压（BP）、脉搏（HR）、呼吸（R）、心电图（ECG）和脉搏血养饱和度（spo2）并做记录。建立静脉通道，生理盐水维持，缓慢静脉推注安定1～2mg，鼻导管给氧。按常规胃镜检查摆好体位，放好口套后缓慢静脉推注异丙酚（1～2mg／kg），注药速度为40～60mg／min。待病人达到镇静程度后即开始插镜检查。结果120例无痛胃镜中出现呼吸停顿1例，遗忘程度100％。结论异丙酚、安定联合应用在无痛胃镜中镇静效果确切，呼吸抑制弱，病人遗忘程度100％。

Altered spontaneous contractions of the ileum by anesthetic agents in rats exposed to peritonitis

AIM： To investigate in vitro effects of propofol, midazolam and dexmedetomidine, which are commonly used anaesthesic or sedatives, on spontaneous contractions of the ileum both in normal rats and those exposed to hyperdynamic peritonitis.METHODS： Spontaneous contractions of isolated ileum muscle segments from sham operated rats and those exposed to peritonitis, were studied in vitro. The amplitude and the frequency of spontaneous contractions of ileum muscle segments were studied after adding dexmetetomidine, propofoi, and midazolam to the organ bath in a cumulative manner.RESULTS： Both amplitude （85.2 ± 6.6 vs 47.4 ± 7.1） and frequency （32.8 ± 4.6 vs 20.2 ± 3.9） of spontaneous contractions in ileum smooth muscle segments were decreased significantly in the peritonitis group compared to the control group （P 〈 0.05）. Dexmedetomidine significantly increased the amplitude of spontaneous contractions （85.2 ± 6.6 vs 152.0 ± 5.4, P 〈 0.05） whereas, propofol （85.2 ± 6.6 vs 49.6 ± 4.8, P 〈 0.05） and midazolam （85.2 ± 6.6 vs 39.2 ± 4.5, P 〈 0.05） decreased it in both control and peritonitis groups. The frequency of spontaneous contractions were significantly decreased by propofol in both control （32.8 ± 4.6 vs 18.2 ± 3.4, P 〈 0.05） and peritonitis groups 20.2 ± 3.9 vs 11.6 ± 3.2, P 〈 0.05）. Dexmedetomidine and midazolam did not cause significant changes in the number of spontaneous contractions in both control and the peritonitis groups （P 〉 0.05）.CONCLUSION： Propofol, midazolam and dexmede- tomidine have various in vitro effects on spontaneous contractions of the rat ileum. While dexmedetomidine augments the spontaneous contraction of the rat ileum, propofol attenuates it. However, the effects of these compounds were parallel in both control and peritonitis groups.

Propofol vs midazolam plus fentanyl for upper gastrointestinal endomicroscopy:A randomized trial

AIM:To compare the endomicroscopic image quality of integrated confocal laser endomicroscopy(iCLE)and sedation efficacy of propofolvs midazolam plus fentanyl(M/F).METHODS:Consecutive outpatients undergoing iCLE were prospectively recruited and randomized to the propofol group(P group)or M/F group.The patient,performing endoscopist and endoscopic assistant were blinded to the randomization.The quality of endomicro-scopic images and anesthetic efficacy outcomes were blindly evaluated after iCLE examination.RESULTS:There were significantly more good quality endomicroscopic images in the propofol group than in the M/F group(72.75%vs 52.89%,P<0.001).The diagnostic accuracy for upper gastrointestinal mucosal lesions using confocal laser endomicroscopy favors the P group,although this did not reach statistical significance.Adverse events and patient assessment were not significantly different for M/F vs propofol except for more frequent intraprocedural recall with M/F.Procedure duration and sedation times were significantly longer in the M/F group,while the scores of endoscopist,anesthetist and assistant assessment were all significantly better in the P group.CONCLUSION:Sedation with propofol might increase the proportion of good quality endomicroscopic images,and may result in improved procedural efficacy and diagnostic accuracy during iCLE examination.