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。     

丙泊酚和利多卡因在基层胃镜检查中的应用

目的探讨在基层胃镜检查时联合应用丙泊酚和利多卡因的安全性、镇静效果及满意度。方法对696例行胃镜检查的患者,随机分为无痛组336例和对照组360例,无痛组患者检查前先称体重并按计量静脉注射丙泊酚及利多卡因,进入睡眠状态后进行胃镜操作,对照组患者直接进行操作,观察并记录各组检查前、中、后血压、脉搏和血氧饱和度;患者感受和不良反应发生情况。结果无痛组患者检查中和检查结束后较检查前血压、心率均有下降,前后比较无统计学意义(P>0.05);对照组患者检查中和检查结束后血压、心率较检查前有显著上升,有统计学意义(P<0.05);两组检查前、中、后血氧饱和度差异无统计学意义(P>0.05);不良反应:无痛组恶心、呕吐、贲门黏膜撕裂等不良反应明显低于普通胃镜组(P<0.05),呃逆、呛咳等稍高于普通胃镜组(P>0.05)。无痛组患者感受明显好于普通组(P<0.05)。结论患者在严密监测下联合应用丙泊酚和利多卡因行无痛胃镜检查安全、舒适、可行,在基层医院也可推广使用。     

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。     

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。     

小剂量瑞马唑仑复合丙泊酚对无痛胃肠镜检查老年肥胖患者快速康复的影响

目的 分析小剂量瑞马唑仑复合丙泊酚对行无痛胃肠镜检查的老年肥胖患者快速康复的影响。方法 回顾性分析无痛胃肠镜检查的老年患者80例,年龄≥65岁,体质量指数(BMI)28～40 kg/m²,分为舒芬太尼+丙泊酚组(P组)与舒芬太尼+丙泊酚+瑞马唑仑组(R组)每组40例。分别记录麻醉诱导时舒芬太尼、丙泊酚、瑞马唑仑的用药量,丙泊酚追加次数及总用药量;记录麻醉诱导到置入胃镜的时间,胃肠镜检查总时间、肠镜撤出到患者苏醒时间、患者入麻醉恢复室到离院时间;记录给药前,胃镜检查后1、3 min,检查结束时和清醒后5 min平均动脉压、心率和血氧饱和度;记录鼻咽通气道、帕洛诺司琼、麻黄碱和阿托品的使用情况。结果 与P组比较,胃镜检查后1、3 min, R组平均动脉压和血氧饱和度升高,镇静时间、恢复时间缩短,不良反应发生率降低,均有统计学差异(P<0.05)。结论 小剂量瑞马唑仑复合丙泊酚用于老年肥胖患者行无痛胃肠镜检查能减少丙泊酚用量,缩短离院时间,血流动力学更稳定,不良反应更少,促进老年患者快速康复。     

丙泊酚和芬太尼在老年高血压患者无痛胃镜检查中的应用研究

目的探讨丙泊酚和芬太尼联合应用在老年原发性高血压(高血压)患者无痛胃镜检查中的有效性和安全性。方法选取81例行胃镜检查的老年高血压患者,40例静脉注射芬太尼和丙泊酚的患者设为观察组,41例行普通胃镜检查的患者设为对照组。记录两组的检查时间、收缩压、舒张压、心率、脉搏氧饱和度。观察时间点:检查前(T0)、准备进镜前(T1)、胃镜经食道入口平面(T2)、胃镜取活检(T3)、检查后(T4)。结果两组治疗前收缩压、舒张压、心率、脉搏氧饱和度及检查时间比较,差异无统计学意义(P>0.05)。观察组检查过程中的收缩压、舒张压、心率较检查前显著下降,差异有统计学意义(P<0.05);且明显均低于对照组检查过程中对应的时间点;但脉搏氧饱和度变化幅度不大,与检查前比较,差异无统计学意义(P>0.05)。结论丙泊酚和芬太尼联合应用于老年高血压患者胃镜检查是安全、有效的。     

鼻胃镜与普通胃镜对老年患者上消化道疾病诊治的临床对照研究

目的 评价鼻胃镜与普通胃镜应用于老年患者上消化道疾病诊疗的耐受性、临床价值及安全性.方法 对有上消化道疾病的116例老年患者（≥60岁）分别予以鼻胃镜、普通胃镜检查（每组各58例）,对患者胃镜检查前、中、后的收缩压、舒张压、心率、呼吸频率、血氧饱和度及检查过程中的不适反应进行观察.结果 普通胃镜组收缩压、舒张压、心率较检查前有显著性升高,差异有统计学意义（P＜0.05）,血氧饱和度和呼吸频率无明显变化（P＞0.05）;鼻胃镜组患者收缩压、舒张压、心率与检查前比较升高,血氧饱和度及呼吸频率略低于检查前,但差异均无统计学意义（P＞0.05）.鼻胃镜组患者视觉模拟评分法（VAS）痛苦评分低于普通胃镜组,差异有统计学意义（P＜0.01）.结论 鼻胃镜的安全性及耐受性均优于普通胃镜,对于不能耐受普通胃镜检查的老年患者,鼻胃镜不失为一种安全、可行的内镜检查方法.     

无痛肠镜和普通肠镜检查应用于老年患者的效果及安全性比较

目的比较老年患者应用无痛肠镜和普通肠镜检查的效果和安全性。方法选择2013年1月至2014年8月该院门诊和住院接受肠镜检查的老年患者100例,按照检查方法分为无痛肠镜组54例和普通肠镜组46例,分别进行无痛肠镜和普通肠镜检查,比较两组检查前和检查过程中血压、心率、血氧饱和度变化及操作时间、成功率和不良反应。结果无痛肠镜组患者检查中收缩压、舒张压、心率和血氧饱和度与检查前比较无统计学意义(P0.05),但显著低于普通肠镜组(P0.05),普通肠镜组患者检查中收缩压、舒张压、心率较检查前显著升高(P0.05),血氧饱和度与检查前比较无统计学差异(P0.05);两组操作时间比较无统计学差异(P0.05),无痛肠镜组成功率、恶心呕吐、头疼、心动过缓发生率高于普通肠镜组,但差异无统计学意义(P0.05),腹胀、腹痛发生率显著低于普通肠镜组义(P0.05)。结论无痛肠镜检查对于老年患者具有良好的安全性,患者在接受检查时不良反应较低,值得临床推广。     

高血压病患者常规胃镜与无痛胃镜检查的观察与护理干预体会

目的研究高血压病患者常规胃镜与无痛胃镜检查的应用效果与护理干预效果。方法根据随机数字表法将2019年1-12月期间在本院进行检查的高血压病患者120例分为两组,对照组60例进行常规胃镜检查和常规护理,观察组60例进行无痛胃镜检查和综合护理干预。将两组的血压、心率、血氧饱和度、焦虑评分、检查时间、不良反应发生率进行比对。结果两组检查前、检查中、检查时的血压、心率、血氧饱和度进行比较,差异具有统计学意义(P0.05);观察组患者干预后的焦虑评分、不良反应发生率低于对照组,检查时间短于对照组,差异具有统计学意义(P0.05)。结论对高血压病患者实施无痛胃镜检查以及综合护理干预更有助于稳定生命体征和心理状态,可缩短检查时间,减少不良反应。     

脑电双频指数在老年人无痛胃镜检查中的应用

目的探索不同脑电双频指数(BIS)的麻醉深度对门诊择期行无痛胃镜检查老年患者的影响。方法随机选取80名60~75岁拟在门诊行无痛胃镜检查的老年患者按照随机数字表法分为两组:A组BIS值控制在40~45之间,B组BIS值控制在55~60之间。监测并记录两组患者麻醉诱导前(T0),麻醉诱导后入镜前(T1),检查结束时(T2)的平均动脉压(MAP),心率(HR),脉搏血氧饱和度(SpO_2)等血流动力学指标,同时比较两组患者的麻醉苏醒时间及有无发生术中知晓。结果 A组在麻醉诱导后平均动脉压和心率较B组出现较明显降低(P0.05),且麻醉苏醒时间较B组延长(P0.05)。两组患者均未发生术中知晓。结论在避免老年患者发生术中知晓的情况下,将麻醉深度控制在BIS值为55~60时可有效抑制胃镜检查时的手术刺激诱导的一系列应激反应,同时维持平稳的循环系统血流动力学,并达到满意的麻醉效果。     

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。     

老年冠心病患者经鼻胃镜检查的安全性分析

目的探讨老年冠心病患者经鼻胃镜检查的安全性。方法选择2012年1月至2012年12月在北京老年医院接受胃镜检查的65岁以上老年患者100例,分为经鼻胃镜及普通胃镜组（各50例）,每组再分为冠心病及非冠心病（各25例）,比较各组胃镜检查中心率、血压、血氧饱和度、心肌耗氧量及心电图变化。结果普通胃镜检查中,冠心病患者心率、血压、心肌耗氧量增加较非冠心病患者明显（P＜0.05）,血氧饱和度下降值较非冠心病患者高（P＜0.05）,冠心病患者心律失常及ST段下移发生率较非冠心病患者高（P＜0.05）;冠心病患者经鼻胃镜检查中,心率、血压、心肌耗氧量增加值较普通胃镜明显低（P＜0.05）,血氧饱和度下降值低（P＜0.05）,心律失常及ST段下降发生率低（P＜0.05）。结论老年冠心病患者经鼻胃镜检查耐受性好,对心血管影响小,安全性高。     

Sedation, topical pharyngeal anesthesia and cardiorespiratory safety during gastroscopy

GOALS: In a prospective, double-blind study, we examined the effects of routine sedation and pharyngeal anesthesia on cardiorespiratory parameters during gastroscopy. BACKGROUND: Intravenous sedation and topical pharyngeal anesthesia are used to alleviate the discomfort during upper gastrointestinal endoscopy. Cardiorespiratory changes during gastroscopy are common. STUDY: Two hundred fifty two consecutive outpatients undergoing gastroscopy were assigned into 4 groups: (1) sedation with intravenous midazolam and placebo throat spray (midazolam group), (2) placebo sedation and pharyngeal anesthesia with lidocaine throat spray (lidocaine group), (3) placebo sedation and placebo throat spray (placebo group), and (4) no intravenous cannula nor throat spray (control group). Arterial oxygen saturation (SaO2), systolic and diastolic blood pressure and continuous electrocardiogram were recorded before, during, and after the endoscopic procedure. RESULTS: Gastroscopy increased heart rate in all study groups. Premedication with intravenous midazolam or lidocaine spray alleviated this rise (P<0.001, repeated measures analysis of variance) and decreased the incidence of tachycardia. Similarly, sedation with midazolam or topical pharyngeal anesthesia decreased the rise in systolic blood pressure (P<0.001). Midazolam produced lower SaO2 values during gastroscopy compared with lidocaine, placebo or control groups (P<0.001). However, episodes of desaturation (SaO2 相似文献   

经鼻胃镜检查的临床应用价值

背景：经鼻胃镜检查被医师和患者普遍接受,已广泛应用于临床诊断和治疗。目的：探讨经鼻胃镜检查的临床应用价值。方法：连续选取2008年4月拟接受胃镜检查的243例患者,随机分为经口胃镜组（n=138）和经鼻胃镜组（n=105）,分析两组患者恶心、呕吐发生率、疾病谱分布以及术前与术中心率、收缩压和氧饱和度差值。结果：经口胃镜组恶心、呕吐发生率以及术前与术中心率差值、收缩压差值显著高于经鼻胃镜组（P〈0．05）．但两组疾病谱分布和氧饱和度差值无明显差异。结论：与经口胃镜检查相比,接受经鼻胃镜检查者的恶心、呕吐反应小,术中心率和收缩压波动小,且疾病谱分布无明显差异。因此,经鼻胃镜检查具有良好的临床应用前景。     

高海拔地区无痛胃镜检查的临床观察

目的:探讨高海拔地区丙泊酚iv行无痛胃镜检查的安全性和镇静效果.方法:自愿接受者36例,采用单纯丙泊酚(1.0-1.5mg/kg)iv施行无痛胃镜检查.观察术中心率(HR)、血压(SBP,DBP)、呼吸(RR)、血氧饱和度(SpO2)的变化及苏醒时间、术中不适、记忆缺失、自我感觉等情况.结果:无痛组患者均顺利完成检查,无严重不良反应发生,检查后患者感觉满意者36例(100%),舒适者33例(91.67%),无1例感觉难受,与普通组比较差异有显著性意义(P<0.01).无痛组在胃镜检查过程中HR,SBP,DBP,RR有不同程度的下降,但大多数波动在正常范围;SpO2在全程吸氧下能维持平稳,与普通组相比,其差异均具有显著意义(P<0.01).结论:丙泊酚iv行无痛胃镜检查是一种安全、舒适、有效的方法,在高海拔地区值得推广应用.     

Effects of supplemental oxygen on cardiac rhythm during upper gastrointestinal endoscopy: a randomised controlled double blind trial.

To investigate the effects of supplemental oxygen on cardiac rhythm during gastroscopy, 103 patients aged over 60 were randomised to receive either supplemental oxygen or air at 2 litres/minute during the procedure. Pulse rate, blood pressure, oxygen saturation, and a Holter cardiac trace were monitored before, during, and for one hour after the gastroscopy. A wide range of electrocardiographic abnormalities were recorded in both oxygen and air groups, of which ventricular and supraventricular ectopic beats were the most common. There were no significant differences in the rate of occurrence of any clinically important cardiac abnormality either between the oxygen and air groups or between the three monitored periods before, during, and after gastroscopy. There were significantly fewer patients, however, with supraventricular extra systoles when oxygen was given during gastroscopy (p < 0.05). Although supplemental oxygen during gastroscopy significantly improved oxygen saturation (p < 0.001; 95% confidence intervals for the difference between the means: 2.9 to 4.7), there was no correlation between oxygen saturation and any electrocardiographic changes. It is concluded that electrocardiographic abnormalities are common in patients over 60, but this study found no evidence that they are induced by gastroscopy. Supplemental oxygen increases oxygen saturation but does not reduce the incidence of clinically important cardiac arrhythmias.     

Clinical analysis of propofol deep sedation for 1,104 patients undergoing gastrointestinal endoscopic procedures： A three year prospective study

AIM: To analyze the hemodynamic and respiratory effects of propofol on patients undergoing gastroscopy and colonoscopy. METHODS: In this prospective study, conducted over a period of three years, 1,104 patients referred for a same day GI endoscopy procedure were analyzed. All patients were given a propofol bolus (0.5-1.5 mg/kg). Arterial blood pressure (BP) was monitored at 3 min intervals and heart rate and oxygen saturation (SpO2) were recorded continuously by pulse oximetry. Analyzed data acquisition was carried out before, during, and after the procedure. RESULTS: A statistically significant reduction in mean arterial pressure was demonstrated (P<0.001) when compared to pre-intervention values, but severe hypotension, defined as a systolic blood pressure below 60mmHg, was noted in only 5 patients (0.5%). Oxygen saturation decreased from 96.5% to 94.4 % (P<0.001). A critical decrease in oxygen saturation (<90%) was documented in 27 patients (2.4%). CONCLUSION: Our results showed that propofol provided good sedation with excellent pain control, a short recovery time and no significant hemodynamic side effects if carefully titrated. All the patients (and especially ASA III group) require monitoring and care of an anes- thesiologist.     

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.