无痛胃肠镜麻醉临床应用体会(1)
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[摘要] 目的：探讨应用异丙酚实施无痛胃肠镜检查的临床价值及体会。方法：将2009年5月～2011年5月收治的260例患者随机分为A组(丙泊酚联合芬太尼组)、B组(丙泊酚联合氯胺酮组)行麻醉进行胃肠镜检查。观察患者苏醒时间、离院时间、BP、HR、SpO2及不良反应率情况。结果：所有患者均顺利完成胃肠镜检查。两组患者检查后HR、BP、SpO2变化比较，差异无统计学意义(P>0.05)。两组患者呼吸抑制率、恶心呕吐率比较，差异均有统计学意义(P < 0.05)。结论：应用异丙酚联合芬太尼/氯胺酮实施静脉全麻均能顺利完成无痛胃肠镜检查，值得临床推广应用。术前应多了解患者的病史和体检情况，术中密切观察可减少不良反应，避免并发症。
[关键词] 无痛；胃肠镜；异丙酚；诊断和治疗；麻醉
[中图分类号] R614 [文献标识码] A [文章编号] 1674-4721(2012)01(b)-084-02
Clinical application of anesthesia painless gastroscopy
SONG Junling
The Central Hospital of Zhengzhou City in Henan Province, Zhengzhou 450007, China
[Abstract] Objective: To explore the implementation of propofol painless gastrointestinal endoscopy and clinical value of experience. Methods: Two hundred and sixty patients from May 2009 to May 2011 were randomly divided into group A (propofol combined with fentanyl group), group B (propofol combined with ketamine group) anesthesia for gastrointestinal endoscopy. To observe the recovery time, discharge time, BP, HR, SpO2 and the rate of adverse reactions. Results: All patients were successfully completed during gastrointestinal endoscopy. HR, BP, SpO2 of two groups compared, the difference were not statistically significant (P>0.05). Respiratory depression rate, nausea, vomiting, discharge rate of two groups compared, the differences were statistically significant (P<0.05). Conclusion: Application of propofol combined with fentanyl/ketamine intravenous anesthesia can successfully implement painless gastrointestinal endoscopy, is worthy of clinical application. Preoperative learn more about the history and physical examination, surgery can reduce the adverse reactions observed closely to avoid complications.
[Key words] Painless; Gastroscopy; Propofol; Diagnosis and treatment; Anesthesia
治疗性内镜检查因其较大痛苦和不适，使患者难以接受，许多患者因此放弃诊治，延误疾病的诊断。无痛性内镜检查是近年来发展的新技术[1]，具有高清晰度、高分辨率、胃镜内检查无死角、无损伤、高诊断率，检查与治疗安全、时间短、诊断率高的优点。其能检查也能治疗，通过内镜活检孔道，将内镜注射针送入胃内，可在直视下对病变部位做药物注射，如：硬化剂、抗癌药等。它的出现从根本上解决了胃肠镜检查给患者带来的痛苦，促进了该项检查的广泛开展[2]。笔者所在医院2009年5月～2011年5月采用芬太尼/氯胺酮与丙泊酚联合静脉全麻下行无痛胃肠镜诊疗，取得满意疗效，现报道如下：
1 资料与方法
1.1 一般资料
选择笔者所在医院2009年5月～2011年5月收治的260例患者为研究对象，均自愿接受胃肠镜检查，其中，男132例，女128例；年龄29～79岁，平均(53.2±5.3)岁；体重19～91 kg；ASA Ⅰ～Ⅱ级；胃镜检查89例，肠镜检查121例 ......
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