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1、老年無痛胃鏡麻醉安全性體會(huì)【摘要】目的比較丙泊酚與依托咪酯聯(lián)全應(yīng)用能否揚(yáng)長(zhǎng)避短，使老年無痛胃鏡檢麻醉更平穩(wěn)，減少麻醉相關(guān)并發(fā)癥。方法300例老年患者擇期行無痛胃鏡檢查術(shù)，采用抽簽隨機(jī)雙盲法分為3組。A組：咪唑安定+丙泊酚+芬太尼；B組：咪唑安定+依托咪酯+芬太尼；C組：咪唑安定+芬太尼+丙泊酚+依托咪酯。術(shù)中監(jiān)測(cè)ECG、BP、RR、SP02。觀察術(shù)中體動(dòng)、低氧血癥、心動(dòng)過緩、低血壓、肌陣攣、術(shù)中遺忘及術(shù)后惡心嘔吐、肌痛等不良反應(yīng)。記錄丙泊酚首次用量和總用量及依托咮酯首次用量及總用量，記錄鏡檢時(shí)間、蘇醒時(shí)間（從退出鏡子到患者容易喚醒，服從
2、命令的時(shí)間）。結(jié)果三組術(shù)前血壓、心率、SP02無顯明差異，均順利完成檢查。A組麻醉前后心率、血壓、SP02麻醉前后均有不同程度下降，有3例因SP02下降到85%以下而暫停檢查，28例血壓下降明顯，低于警戒值而靜注升壓藥。無術(shù)后惡心嘔吐及肌痛等不良反應(yīng)。B組麻醉前后心率、血壓、SPO2變化不大，術(shù)中體動(dòng)、肌松不良、肌陣攣、嗆咳，及術(shù)后惡心躁動(dòng)發(fā)生率較高。C組血壓、心率、SP02較穩(wěn)定，麻醉前后無明顯差別。C組清醒時(shí)間明顯縮短，丙泊酚依托咪酯用量明顯減少。詳見表1、表2、表3。結(jié)論丙泊酚聯(lián)合依托咪酯伍用小劑量的芬太尼及咪唑安定平衡麻醉優(yōu)勢(shì)互
3、補(bǔ)、揚(yáng)長(zhǎng)避短，能使老年病人無痛胃鏡檢查時(shí)血壓、心率更穩(wěn)定，呼吸抑制更小，蘇醒更快，降低了依托咪酯相關(guān)的肌陣攣以及術(shù)后惡心嘔吐發(fā)生率。提高了老年無痛胃腸鏡檢的安全性和舒適性。【關(guān)鍵詞】丙泊酚依托咪酯老年無痛胃鏡分類號(hào)：R614ZZZZZ文獻(xiàn)標(biāo)識(shí)碼：A文章編號(hào)：1005-0515(2011)6-009-02SafetyofoldergastroscopyanesthesiaexperienceHeFangkun(SichuanProvince,theSecondPeople'sHospitalofJintangCounty,Chengdu6
4、10401)[Abstract]ObjectiveTocomparepropofolandetomidate,allapplicationstogethercanexceedandpainlessgastroscopyexaminationofoldermorestableanesthesia,reduceanesthesia-relatedcomplications.Methods300casesofelderlypatientsundergoingelectivepainlessgastroscopy,randomizeddoubl
5、e-blindballotdividedinto3groups.A：Midazolam+propofol+fentanyl；Bgroup：midazolam,etomidate+fentanyl；CGroup：midazolam+fentanyl+propofol+etomidate.IntraoperativemonitoringofECG,BP,RR,SP02.Intraoperativeobservationofbodymovement,hypoxia,bradycardia,hypotension,myoclonus,intra
6、operativeandpostoperativenauseaandvomitingforgotten,musclepainandotheradversereactions.Recordandthefirstdosageofpropofolandetomidate,thetotalamountofthefirstamountandthetotalamount,recordexaminationtime,recoverytime(fromtheexitmirrorwereeasiertowakeup,obeyordersofthetime
7、).ResultsThepreoperativebloodpressure,heartrate,SPO2noobviousdifferences,boththesuccessfulcompletionofinspection.Agroupofanesthesiabeforeandaftertheheartrate,bloodpressure,SPO2weredecreasedafteranesthesia,3patientsdroppedto85%forSPO2suspendedthefollowingexamination,28pat
8、ientsbloodpressuredroppedsignificantly,lowerthanthewarningvalueofintravenousvasopressors.Nopostoperativ
