瑞芬太尼联合异丙酚与芬太尼联合异丙酚用于镇静无痛苦胃镜检查的效果及安全性的对比研究

目的探讨瑞芬太尼（Rem）联合异丙酚（Pro）与芬太尼（Fen）联合异丙酚（Pro）用于无痛胃镜检查的效果及安全性。方法331例胃镜受检者随机分为Rem—Pro组（Ⅰ组），Fen—Pro组（Ⅱ组）和对照组（Ⅲ组，常规胃镜）。比较各组受检者术中不适反应，药物起效及停药后神智的恢复时间，胃镜操作时间，检查前、中、后的血压（BP）、心率（HR）、血氧饱和度（SPO2）、去甲肾上腺素（NE）变化及术后问卷调查。结果Ⅰ、Ⅱ组术中不适反应少，胃镜操作时间短（P〈0．05），100％受检者愿复查（P〈0．01）。Ⅰ、Ⅱ组BP、HR、SPO2多在正常范围内一过性下降（P〈0．01），Ⅲ组术中BP、HR显著升高。Ⅰ组BP恢复时间、苏醒、清醒时间较Ⅱ组更短（P〈0．01）。Ⅲ组术后NE升高更显著（P〈0．01）。结论Rem联合Pro和Fen联合Pro均能抑制胃镜检查的不适反应，安全舒适。Rem联合Pro不适反应更少、血压、神智恢复时间更短，更适于无痛苦胃镜检查。

Evaluation of the Effect and Security on Remifentanil-Propofol and Fentanyl-Propofol in Gastroscopy

Objective： To evaluate the sedative and analgesic efficiency and security of remifentanil-propofol and fentanyl-propofol by intravenous injection in gastroscopy. Methods： 331 patients were randomly divided into three groups： remifentanil-propofol （group Ⅰ ）, fentanyl-propofol （group Ⅱ） and ordinary gastroscopy group （group Ⅲ, as control）. The variation of BE FIR, SPO2, and the reaction of patients during examination were observed. The serum norepinephrine concentrations were measured before and after gastroscopy. Questionnaires for patients were performed after gastroscopy. Results： All operations were completed easily without significant complication. Much less discomfort of patients were observed in group Ⅰ and Ⅱ than in groupⅢ （P〈0.01）.The time of operation in group Ⅰ and Ⅱ were shorter than in groupⅢ （P〈0.01）. The awaken time in group Ⅰ was shorter than in group Ⅱ （P〈0.01）.The BP and SPO2 decreased during the procedure in group Ⅰ and Ⅱ, however, they recovered to baseline immediately after gastroscopy. HR and BP during the procedure increased significantly in group Ⅲ than in group Ⅰand Ⅱ （P〈0.01）. All serum NE concentrations were increased after gastroscopy （P〈0.01）, and significantly higher in group Ⅲ than in group Ⅰ and Ⅱ （P〈0.01）. Conclusion： Using remifentanil-propofol and fentanyl-propofol via intravenous injection can reduce stress in gastroscopy and make gastroscopy more comfortable, more effective and safer, especially remifentanil-propofol is more suitable for gastroscopy with sedation.