【作者】 罗咏萍；

【导师】 梅浙川；

【作者基本信息】 重庆医科大学 ， 消化内科， 2004， 硕士

【摘要】 目的：探讨联合芬太尼-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361例接受胃镜检查者随机分为3组，即芬太尼-异丙酚组(Ⅰ组，131例)，咪唑安定—异丙酚组(Ⅱ组，130例)和对照组(Ⅲ组，100例，常规操作不给镇静镇痛药)。观察记录各组受检者术中的反应、胃镜操作时间、麻醉药物起效时间、受检者苏醒时间和清醒时间，检查前中后血压、心率、脉搏血氧饱和度和SDNN(正常R-R间期标准差)的变化，麻醉药物的用量及术后问卷调查。 结果：芬太尼-异丙酚组与咪唑安定-异丙酚组的受检者术中不适反应少，胃镜操作时间短，与对照组比较有显著性差异(P＜0.05)。对照组的受检者术中血压及心率增高显著，SDNN明显下降，特别是老年人(≥60岁)和高血压患者，较术前比均有显著性差异(P＜0.05)。Ⅰ组药物的起效快，受检者的苏醒及清醒时间短，术中不适反应少，与Ⅱ组比较有显著性差异(P＜0.01)。Ⅰ、Ⅱ组受检者术中均有血压下降和心率减慢，但术后都很快恢复。Ⅰ、Ⅱ组的老年人及高血压受检者苏醒和清醒时间长，麻醉药物剂量少，术中血液循环系统稳定。 结论：胃镜检查前使用芬太尼-异丙酚或咪唑安定-异丙酚镇静镇‘戴先爵赵才号断研丫.笋夕讼戈‘痛是舒适安全的，特别是用于老年人及高血压病患者(1一2级)，但老年人麻醉药物的用量须减少。芬太尼一异丙酚起效快，恢复时间短，不适反应少，更适合门诊胃镜检查。更多还原

【Abstract】 Objective: To study the effect and reliability between association of fentanyl-propofol and midazolam-propofol on sedation and analgesia in gastroscopy.Methods: Three hundred and sixty-one patients undergoing gastroscopy were randomly divided into three groups.One hundred and thirty-one patients (group I ) were given intravenous fentanyl and propofol.One hundred and thirty patients (group II ) were given intravenous midazolam and propofol.One hundred patients (group III,the control group) were not given any intravenous analgesic.Patients’ reactions, sedative effects, variation of Bp,SaO2,HR,SDNN and the dosage of anesthetic were observed.Questionnaires were recorded after gastroscopy .Result: Patients in group I and II fell much less discomfort than group III(P<0.05) .The time of operation is much shorter in group I andII than in group III(P<0.05). BP and HR were significantly higher and SDNN was remarkablely lower especially in the old (more than sixty years) and patients with hypertension of the control group in the process of gastroscopy than before the operation. The effects by drugs on group I were taken faster than those on group II (P<0.01). It took less time for patients in group I to recover from sleeping than patients in group II (P<0.01). BP and HR were significantly decreasing in group I and II patients in gastroscopy,but after that they would return to be normal in short time.The old and patients with hypertension need a few dosage of drugs but need longer recovery time, and their blood circulation is stable in the operation.Conclusion: With the intravenous use of either fentanyl-propofol or midazolam- propofol ,gastroscopy can be performed effectively and safely,especially advantaged to the old and patients with hypertension(grade 1-2). Association of fentanyl-propofol would be suitable to be used in gastroscopy of out-patient clinic.更多还原