内镜黏膜下剥离术的麻醉方法比较

目的比较单纯丙泊酚镇静和气管插管复合麻醉下行内镜黏膜下剥离术(ESD)中的血流动力学变化及不良反应的发生情况。方法P组患者在单纯丙泊酚诱导及维持下行ESD,而G组患者在气管插管复合麻醉下行ESD。记录两组患者诱导前、术中及术毕的SBP、DBP、MAP、HR、SpO2,观察术中的不良反应如舌根后坠、低氧血症、心律失常、体动、呛咳及面颈部气肿和出血等情况。结果P组术中SBP、DBP、MAP较诱导前及G组明显升高、HR明显增快(P<0.05),SpO2有所下降;P组不良反应的发生率舌根后坠为76%,低氧血症为33%,心律失常为22%,体动和呛咳为67%,皮下气肿为22%,出血为11%,均明显高于G组(P<0.05)。结论单纯丙泊酚静脉镇静行ESD术中麻醉较浅,血流动力学不稳定,不良反应的发生率显著增高,麻醉和手术风险加大;而气管插管复合麻醉则安全、可靠。

Comparison of two methods of anesthesia for endoscopic submucosal dissection

Objective To compare the hemodynamics and adverse reactions during endoscopic submucosal dissection(ESD)between simple-propofol-sedation and general anesthesia combined with endotracheal intubation.Methods Patients in group P were simply anesthetized with propofol,while those in group G under general with endotracheal intubation.SBP,DBP,MAP and SpO2 were recorded before,during and at the end of operation.The adverse affairs during operation such as lingual root fall behind,hypoxemia,arrhythmia,body movement,emphysema on the face and neck,cough and bleeding were observed as well.Results Introperative BP and HR in group P were significantly higher than those before and in group G(P<0.05),and SpO2 decreased obviously(P<0.05).Adverse affairs in group P were lingual root fall behind in 76%,hypoxemia in 33%,emphysema in 22% and bleeding in 11%.Conclusion Propofol-sedation could not provide enough anesthetic depth for ESD.