异丙酚并芬太尼在胃镜检查中的应用

目的观察异丙酚并芬太尼在胃镜检查中的应用效果。方法病人分为观察组和对照组，观察组先给芬太尼0．5μg／kg静脉注射，再缓慢静脉注射异丙酚（得普利麻）1．5mg／kg，病人进入睡眠状态后进镜，有异常躁动者追加异丙酚0．5mg／kg。对照组为常规法胃镜检查组．分别监测并记录两组胃镜操作前、操作中和操作后血压、心率、血氧饱和度，记录操作及完成时间、检查中不良反应、检查后询问受检者的感受、复检意向。结果观察组病人没有出现严重并发症。平均血氧饱和度、血压、心率有一过性轻度下降，但与对照组比较无显著差异（P〉0．05）。观察组检查成功率比对照组高。检查反应比对照组低；病人满意度达100％。结论应用异丙酚、芬太尼静脉注射进行无痛性胃镜检查可免除病人痛苦，是一种安全有效的人性化检查技术。     

咪唑安定联合芬太尼在无痛胃镜检查中的应用

目的探讨咪唑安定联合芬太尼在胃镜检查中的应用效果及安全性。方法随机选择在惠州市中心人民医院胃镜室接受胃镜检查的400例患者，将其分为对照组（m=200）和麻醉组（m=200）。对照组患者咽部经喷雾利多卡因局麻后，常规进行胃镜检查；麻醉组患者咽部局麻后，静脉注射咪唑安定（0．05mg/kg）和芬太尼（0．5mg），使患者进入睡眠状态后立即行胃镜检查。两组患者在胃镜检查中均监测血压、心率、指脉搏血氧饱和度，观察检查中患者的反应以及操作时间和成功率，并在检查后询问患者的感受。结果在胃镜检查中，麻醉组患者心率和收缩压均较对照组低（P〈0．05），两组指脉搏血氧饱和度差异无显著性（P〉0．05），麻醉组不良反应发生率明显低于对照组，感觉难受和不适患者所占的比例较小（2％），感觉尚可和舒适的比例较大（98％），对照组则相反，而麻醉组检查成功率、操作时间与对照组比较差异无统计学意义。结论咪唑安定联合芬太尼进行胃镜检查安全、舒适、有效。     

老年高血压患者胃镜检查时生命体征的监测分析

目的观察老年高血压患者胃镜检查时心率、血压、血氧饱和度、心电图等变化,探讨高血压患者行胃镜检查的安全性。方法分析老年高血压患者及血压正常患者胃镜检查时心率、血压、血氧饱和度、心电图的变化,并进行比较。结果高血压组与对照组的心率于胃镜检查中均较检查前升高（P〈0．05）,组间比较亦有统计学差异（P〈0．01）。2组收缩压和舒张压检查中与检查前相比均有升高,血氧饱和度均有不同程度的下降（P〈0．05）,但组间比较无统计学差异。2组于检查中均有心律失常发生,但无危险性心律失常。结论血压、心率控制在安全范围内,老年高血压患者行胃镜检查是安全的。     

无痛胃镜134例临床应用体会

目的研究异丙酚和咪唑安定在胃镜检查中的麻醉效果及安全性。方法随机分为无痛胃镜组（134例次）和普通胃镜组（166例次）。无痛胃镜组咽部喷雾2％的利多卡因后，静脉注射咪唑安定和异丙酚，意识消失后，立即进行胃镜检查。普通胃镜组只给予咽部喷雾2％的利多卡因后进行检查。两组患者在胃镜检查中均监测血压、心率、呼吸及氧饱和度的变化，观察术中患者的反应、并发症及医生对胃镜视野清晰、食管蠕动的满意度。结果无痛胃镜组患者无明显不适，未出现难以耐受的不适，咳嗽、恶心、呕吐均较普通胃镜组明显减少（P〈0．05）；无痛胃镜组术中血压有不同程度的下降，均为一过性。两组患者氧饱和度均有不同程度的下降，与进镜前比较，差异有统计学意义（P〈0．05），但两组间比较无显著变化（P〉0．05）。无痛胃镜组患者的心率明显的减慢，与普通胃镜组比较差异有统计学意义（P〈0．05）。结论无痛性胃镜术是一种安全、舒适、有效、简便易行的好技术、好方法。     

胃镜检查时静脉麻醉对高血压肥胖者血氧饱和度的影响

目的研究胃镜检查时丙泊酚联用芬太尼静脉麻醉下对高血压病肥胖患者血氧饱和度的影响。方法收集我院两年来190例高血压病肥胖患者静脉麻醉下胃镜检查的临床资料,另取同期体重、血压均正常的胃镜检查者200例为对照组,比较在相同检查方式下两组患者血氧饱和度（SpO2）的最低值和SpO2最低时的血压、心率变化。结果所有检查者均顺利完成检查;高血压病肥胖组SpO2最低值为（91．8±7．8）％,对照组SpO2最低值为（96．7±1．6）％,高血压病肥胖组SpO2下降程度明显低于对照组（P〈0．05）;SpO2最低时两组血压、心率均相应下降,但变化程度不大,组内前后两观察时点比较差异均无显著性（P〉0．05）。结论高血压病肥胖患者行胃镜检查时,丙泊酚联用芬太尼麻醉可引起血氧饱和度下降,检查前应予充分吸氧,以避免缺氧导致不良后果。     

丙泊酚行无痛胃镜检查诱发谵妄反应1例

1病历摘要 患者，男，72岁，56kg，因剑突下胀痛、暖气反酸2^＋月来我院要求行无痛胃镜检查。术前做血常规、心电图检查正常。常规行用PM-9000型多参数监护仪监测心率、心律、血压、呼吸及指脉血氧饱和度，患者采用左侧卧位，鼻导管持续低流量给氧，建立静脉通道，缓慢静脉注射芬太尼50μg后，继用丙泊酚（四川蜀乐药业有限公司）2．0mg／kg缓慢静脉注射，待患者睫毛反射消失后开始进镜。     

咪唑安定用于胃镜检查82例临床观察

将260例拟行胃镜检查的患者随机分成观察组82例及对照组178例，对照组按常规进行胃镜检查，观察组则在胃镜检查前静脉注射咪唑安定。观察两组检查过程中血压、心率、血氧饱和度、检查反应等。结果观察组心率、血压变化及不良反应（恶心、流涎等）发生率与对照组比较，P〈0．05。认为胃镜检查前静脉注射咪唑安定可增加患者的耐受性，减轻患者痛苦，且安全；镇静程度以Ramsay镇静分级Ⅱ～Ⅲ级状态最佳。     

丁卡因表面麻醉复合神经安定镇痛麻醉在无痛胃镜检查和治疗中的应用

目的探讨丁卡因表面麻醉复合清醒镇静麻醉在无痛胃镜检查和治疗中应用的安全性和依从性。方法105例行无痛胃镜检查患者静注芬太尼1．5μg／kg，氟哌利多2．5～4．0mg，1％盐酸丁卡因注射液口咽腔喷雾，6min后进行胃镜检查，并进行多功能监护。结果所有受检者中90例均可顺利完成检查，无明显因手术操作引起的呛咳，咽喉部无反射（如恶心、呕吐等），无肢体挣扎等表现，检查中血压、心率、氧饱和度均较平稳，其中有13例术中有呛咳给于加深麻醉后好转完成操作。结论丁卡因表面麻醉复合清醒镇静麻醉在胃镜检查应用简单、无痛，安全性高，增加了患者的依从性，值得临床推广。     

高龄老年高血压患者无痛胃镜检查安全性分析

目的观察高龄老年高血压患者无痛胃镜检查时生命体征及术中反应,探讨高龄老年高血压患者行无痛胃镜检查的安全性。方法选取北京老年医院接受胃镜检查的≥80岁老年高血压患者100例,分为试验组（无痛胃镜组）50例,对照组（常规胃镜组）50例,比较两组患者胃镜检查时心率（HR）、收缩压（SBP）、舒张压（DBP）、血氧饱和度（SaO,）变化操作时间（麻醉后行胃镜检查时间）及术中反应。结果胃镜检查中试验组患者SBP、DBP、HR和Sa02显著下降（均P〈0．01）,术后均可恢复正常,对照组患者SBP、DBP、HR均较前显著升高（均P〈0．01）,Sa02显著下降（P〈0．01）,检查中试验组Sa02高于对照组Sa02,但差异无统计学意义（P〉0．05）,试验组胃镜操作时间较对照组稍短,差异无统计学意义（P〉O．05）,试验组不良反应明显低于对照组,差异有统计学意义（P〈0．01）,试验组舒适度明显高于对照组,差异有统计学意义（P〈O．01）。结论高龄老年高血压患者行无痛胃镜检查是安全、舒适的。     

一氧化二氮吸入用于老年患者无痛胃镜检查的效果及安全性

目的探讨一氧化二氮(笑气)吸入用于老年患者无痛胃镜检查中的效果及安全性。方法选取60岁以上老年患者120例,随机分为无痛胃镜检查组和普通胃镜检查组,每组各60例,无痛胃镜检查组在胃镜检查前口服利多卡因胶浆并持续吸入笑气后行胃镜检查,普通胃镜检查组口服利多卡因胶浆后检查。比较两组患者检查中的不适反应情况,以及检查前、中、后血压、心率、血氧饱和度的变化。结果无痛胃镜检查组不适反应明显减轻,与普通胃镜检查相比较差异显著(P0.05),普通胃镜以及无痛胃镜组中患者血压、心率在检查中均增加,但与检查前相比普通胃镜组有明显差异(P0.05),而无痛胃镜组与检查前相比差异无统计学意义(P0.05),血氧饱和度在检查前、中、后无明显变化(P0.05)。结论笑气吸入用于老年患者无痛胃镜检查是一种舒适、安全、有效的方法。     

旁流式呼气末二氧化碳分压监测在消化内镜麻醉中的应用

目的分析旁流式呼气末二氧化碳分压(PETCO₂)监测在消化内镜麻醉中应用的临床价值及意义。 方法选取山东省千佛山医院内镜诊疗科2020年3月至2020年5月期间行消化内镜麻醉患者200例,随机分为试验组(鼻导管吸氧＋PETCO₂监测,n＝100)和对照组(仅鼻导管吸氧,n＝100)。置镜前2 min,静脉注射地佐辛1～3 mg,丙泊酚1.5～3 mg/kg,待患者睫毛反射消失,托下颌无反应时,开始置镜,置镜成功后予丙泊酚3～5 mg/kg^-1·h^-1持续泵注输入直至检查结束。比较两组患者麻醉效果及并发症发生率。 结果两组患者年龄、性别、体质量指数、ASA分级、麻醉诱导时间、内镜检查时间均无差异(P>0.05);试验组患者低氧血症发生率、面罩加压给氧率、恶心呕吐率、丙泊酚用量、苏醒时间低于对照组,差异有统计学意义(P<0.05);试验组呼吸暂停发现次数、托下颌率、挤压胸廓辅助呼吸率高于对照组,差异有统计学意义(P<0.05)。 结论经鼻导管旁流式PETCO₂监测有利于及时观察肺通气状态,指导临床干预,降低并发症,缩短苏醒时间,提高消化内镜麻醉质量。     

七氟醚与异丙酚麻醉对先心病患儿心肌氧化应激的影响

目的:探讨七氟醚对未成熟心肌保护及清除氧自由基（OFRS）作用。方法: 择期行先天性心脏病患儿手术60例,年龄2~9岁,ASA II或III级, 随机分为七氟醚组(30例),和异丙酚组(30例),麻醉诱导时,七氟醚组吸入氧5~6 L/min+40~60 ml/L七氟醚,异丙酚组异丙酚1~2 mg/kg。两组均采用咪达唑仑0.05~0.1 mg/kg,维库溴铵0.1 mg/kg,舒芬太尼1 μg/kg诱导。麻醉维持七氟醚组吸入4 ml/L~8 ml/L的七氟醚,异丙酚组异丙酚1~3 mg/(kg·h)。两组麻醉维持用维库溴铵0.1 mg/kg,每小时追加1次,舒芬太尼30 μg~40 μg/kg。分别于麻醉诱导前（T0）、体外循环开始前（T1）、体外循环开始后（T2）,手术结束即刻（T3）,从桡动脉抽取桡动脉血2 ml,取血浆测定丙二醛(MDA)含量及超氧化物歧化酶(SOD)的活性。结果: 与异丙酚组比较MDA及SOD,T0、T1无显著变化,T2和T3时七氟醚组SOD显著升高（P<0.05）MDA显著降低（P<0.05）。结论: 七氟醚对未成熟心肌保护作用优于异丙酚,其机制与清除OFRS减少氧化应激等有关。     

Heart Rate and Blood Pressure Changes during Gastroscopy in Healthy Older Subjects

BACKGROUND: Previous studies uncontrolled for co-morbidity have shown increased heart rate and decreased oxygenation during gastroscopy in older people. One previous study of selected younger patients suggested that changes in blood pressure were more pronounced in non-premedicated patients. AIMS: To prospectively examine blood pressure and heart rate responses during gastroscopy in healthy older people uninfluenced by medication or co-morbidity. METHODS: Blood pressure and heart rate were monitored continuously in consecutive unselected patients attending for gastroscopy carried out by one endoscopist. RESULTS: Thirty-seven patients were included with a mean age of 51.5 years (95% CI: 17-89); 10 patients were over the age of 65. During gastroscopy there were large increases in blood pressure and heart rate, with maximum changes occurring predominantly at intubation in the younger age group. Typically, increases in blood pressure in the older group occurred later in the procedure and were more sustained. Mean (95%CI) maximum changes in systolic blood pressure were more profound in those sedated [73 (55-91) mm Hg] compared to those having throat spray [47 (34-60) mm Hg; p < 0.05]. Maximum changes in heart rate during gastroscopy became significantly smaller with advancing age in those having throat spray (p = 0.03) but not in those receiving sedation. CONCLUSIONS: Gastroscopy stimulates blood pressure and heart rate changes that are greatest in those sedated. Further studies of the effect of gastroscopy upon blood pressure are required, particularly in older patients, the group regarded as at increased risk from complications.     

雾化吸入布地奈德混悬液对慢性阻塞性肺疾病急性加重期患者的治疗作用及安全性评估

目的　探讨短期雾化吸入布地奈德混悬液对慢性阻塞性肺疾病急性加重期（AECOPD）患者的治疗效果及安全性评估。方法　87例AECOPD患者被随机分为吸入激素组（31例）、全身激素组（27例）和对照组（29例）。三组均给予吸氧、抗感染、氨茶碱及止咳化痰等常规治疗。吸入激素组加用布地奈德混悬液氧气雾化吸入。全身激素组在常规治疗的基础上加用泼尼松龙40mg，静脉给药。三组均于治疗前及治疗7d后测定肺功能、动脉血气及空腹血糖、电解质。结果　治疗前，三组间各指标比较无明显差异。治疗后，三组肺功能及动脉血气较治疗前均有明显改善（P〈0．01或P〈0．05）；吸入激素组与全身激素组比较，除血糖外（P=0．044），各指标差异无显著性（P均〉0．05）；吸入激素组与对照组比较，除pH值外，肺功能、血气指标差异均显著，血糖、电解质比较差异无显著性（P均〉0．05）。结论布地奈德混悬液雾化吸入治疗AECOPD安全有效。     

Propofol sedation in outpatient colonoscopy by trained practice nurses supervised by the gastroenterologist: a prospective evaluation of over 3000 cases

BACKGROUND AND STUDY AIMS: Propofol has several advantages for sedation in endoscopic procedures. Sedation administered by anaesthesiologists is associated with high costs. In this study the safety of propofol sedation administered by trained practice nurses under the supervision of the gastroenterologist in a cohort of outpatients of an ambulatory practice for gastroenterology in Germany is evaluated. METHODS: During a period of 21 months all patients referred to colonoscopy were eligible for this prospective observational study. The familiar CRC risk of the individuals, indication, completeness and results of the colonoscopy were registered together with the dose of propofol used. Propofol was administered by intermittent intravenous bolus titration by trained practice nurses under supervision of the gastroenterologist. Oxygen saturation, heart rate and blood pressure were recorded constantly during the procedure and adverse cardiopulmonary events were monitored by the endoscopy team. A respiratory event was defined as an episode of apnoea or laryngospasm requiring assisted ventilation. 23 % of the patients received supplemental oxygen. RESULTS: A total of 3641 colonoscopies were recorded. 33 individuals were sedated with midazolam and were excluded from the evaluation. 3610 individuals were sedated with propofol (119 +/- 39 mg, mean dose +/- S. D.). 40 % of the procedures were performed as combined gastroscopy and colonoscopy. The cecum was reached in 99 % of the colonoscopies. Respiratory events occurred in five patients (0.14 %). Assisted ventilation in all cases was performed by mask ventilation. Bradycardia (HF < 60/min) and arterial hypotension (RR < 90 mmHg) occurred in 0.5 and 0.3 % of the colonoscopies, respectively, but medical intervention was necessary only in 0.2 % for both types of event. Minor events of hypoxaemia were observed in 51 patients (1.4 %), but only 1/3 of these events occurred in patients supplemented with oxygen. CONCLUSIONS: Propofol can be administered safely for ambulatory colonoscopy by trained practice nurses, with careful monitoring under supervision of the gastroenterologist.     

胃镜检查对心率、血氧饱和度的影响

目的:探讨胃镜检查对各年龄段患者心率、血氧饱和度的影响。方法:对53名不同年龄的患者(被分为老年组、中年组、青年组)分别在胃镜检查的4个阶段(胃镜检查前1 min、经咽-贲门、进入胃腔、退镜后1 min)进行心率和血氧饱和度的监测,并进行比较。结果:心率各组检查前无显著差异,术中各阶段较术前显著增快(P<0.05~<0.01),以经咽-贲门时为最快(P<0.01);术中老年组心率上升幅度较低(P<0.05)。血氧饱和度术前后各组均无显著差异,但老年组的胃镜检查时有所降低。结论:对于老年人,心血管病人的胃镜检查最好是术时进行心电图和血氧饱和度的动态监测,以免不测。     

己酮可可碱吸入对慢性阻塞性肺疾病患者血浆内皮素的影响

目的 探讨己酮可可碱（PTX）吸入对慢性阻塞性疾病（COPD）患血浆内皮素（ET－1）的影响及临床意义。方法 51例COPD患随机单盲分成治疗组（27例）和对照组（24例），分别给己酮可可碱（PTX）100mg加入生理盐水5ml雾化吸入和糜蛋白酶5mg加入生理盐水5ml雾化吸入。治疗前后检查肺功能、动脉血气、肝肾功能及血浆IL－8等。结果 治疗后，治疗组PaCO2下降，PaO2增高（P＜0．05）；IL－8、ET－1明显下降（P＜0．01）和（P＜0．05）；FEV1及FEV1％有所增高，但无统计学意义（P＞0．05）。两组治疗前后肝肾功能均无变化。结论 PTX价廉，吸入不良反应少，不失为临床治疗COPD的一种新方法。     

依托咪酯联合丙泊酚镇静应用于超重患者无痛胃镜检查的效果观察

[目的]比较超重患者无痛胃镜检查中依托咪酯联合丙泊酚与单独使用丙泊酚的效果。[方法]将60例患者随机分为丙泊酚组(P组)和依托咪酯联合丙泊酚组(EP组)。P组在胃镜检查前首次给予1%丙泊酚(1 mg/kg),EP组给予1%丙泊酚(0.5 mg/kg)加依托咪酯(0.1 mg/kg)。后重复给予P组10~20 mg丙泊酚或EP组5~10 mg丙泊酚加1~2 mg依托咪酯,以维持足够的镇静水平。[结果]与T0比较,T1及T2时刻2组患者的收缩压、舒张压、平均动脉压、心率均明显降低,且与EP组相比,P组下降更为显著,差异有统计学意义(P<0.05),EP组麻醉后循环波动较小。与P组相比,EP组患者从静脉注入麻醉药物到患者意识消失的时间更长(P<0.05)。EP组低血压、呼吸抑制以及注射痛的发生例数低于P组,差异有统计学意义(均P<0.05)。[结论]依托咪酯联合丙泊酚对超重患者无痛胃镜检查中的呼吸和循环影响不大,患者苏醒质量高,不良反应少,比单用丙泊酚更安全有效。     

吸入异丙托溴铵联合布地奈德治疗哮喘-慢阻肺重叠综合征的效果探讨

目的以哮喘-慢阻肺重叠综合征患者为研究对象,探讨患者应用吸入异丙托溴铵与布地奈德联合治疗的效果。方法以90例哮喘-慢阻肺重叠综合征患者作为本次研究对象并随机分为两组,为对照组(n=45)患者实施布地奈德吸入治疗,为观察组(n=45)患者实施吸入异丙托溴铵与布地奈德联合治疗。结果治疗前患者FEV1、FEV1/FVC等肺功能指标组间差异显著(P>0.05),治疗后观察组患者FEV1、FEV1/FVC均高于对照组(P<0.05)。观察组0级及I级占比高于对照组,III级及IV级占比均低于对照组(P<0.05),两组患者III级占比差异不显著(P>0.05)。结论哮喘-慢阻肺重叠综合征患者采用异丙托溴铵与布地奈德联合吸入治疗能够使其呼吸困难症状得到有效缓解,肺功能改善效果理想。     

Pulse oximetry saturation levels during routine unsedated diagnostic upper gastrointestinal endoscopy

BACKGROUND: Diagnostic procedures account for over 90% of all upper gastrointestinal endoscopies. Pulse oximetry saturation (SpO2) levels were assessed in patients attending for routine unsedated diagnostic gastroscopy to identify factors associated with oxygen desaturation. METHODS: Three hundred and thirty unsedated patients were monitored with continuous pulse oximetry. A further 154 patients who requested sedation prior to endoscopy were studied as a positive control group. RESULTS: SpO2 levels were lower in sedated compared to unsedated patients (P < 0.0001). Six unsedated patients (2%) desaturated to 90% or less during endoscopy compared to 32 sedated patients (21%) (P < 0.0001). SpO2 levels in unsedated patients were not related to patient sex, age, cigarette smoking, endoscope diameter, basal SpO2 levels or duration of endoscopy. In contrast, examination of the pharyngeal area and epiglottis (P = 0.0002) and a longer intubation time (P = 0.0002) were associated with lower SpO2 levels. The lowest SpO2 level recorded during unsedated endoscopy was 88%. CONCLUSION: Pulse oximetry is not a prerequisite to performing routine unsedated diagnostic gastroscopy in patients without severe systemic disease.