瑞芬太尼复合丙泊酚短时程清醒镇痛镇静术在门诊老年食管异物患者中的应用

目的探索瑞芬太尼复合丙泊酚短时程清醒镇痛镇静技术在食管异物诊疗中的临床应用效果。 方法选取2018年9月至2019年9月于江苏省苏北人民医院内镜中心接受治疗的60例因食管异物就诊的门诊老年患者。采用随机数字表法分为对照组和清醒镇痛镇静组（CA组），各30例。对照组给予单一丙泊酚麻醉，CA组采用短时程镇痛镇静麻醉方案。对比两组Ramsay镇静评分达标时间、术中低血压发生情况、术中低血氧发生情况、额外的麻醉药物追加次数、患者麻醉苏醒达标时间、术后24 h电话随访恶心呕吐等不适症状发生情况、患者满意度以及内镜操作医生满意度。 结果Ramsay镇静评分达标时间CA组显著长于对照组［（50.73±6.78）s vs （24.47±7.00）s］，差异具有统计学意义（t=14.765，P＜0.001）；术中低血压发生情况CA组（20.0%，6/30）显著少于对照组（66.7%，20/30），差异具有统计学意义（χ²=13.303，P＜0.001）；麻醉恢复时间CA组显著短于对照组［（5.63±2.61）min vs （22.63±3.73）min］，差异具有统计学意义（t=20.472，P＜0.001）；术后不适症状发生情况CA组（6.7%，2/30）显著少于对照组（26.7%，8/30），差异具有统计学意义（χ²=4.32，P＜0.05）。术中低血氧发生情况、麻醉药额外追加次数、患者满意度和内镜操作医生满意度组间无显著统计学差异（P＞0.05）。 结论瑞芬太尼复合丙泊酚的短时程清醒镇痛镇静技术既可保证麻醉效果和术后快速康复，又可减轻术后不适症状，是适合于老年食管异物患者的麻醉方案。

Application of short-term conscious analgesia and sedation with Remifentanil and Propofol in elderly outpatients with esophageal foreign body

ObjectiveTo explore the clinical application of short-term conscious analgesia and sedation with Remifentanil and Propofol in elderly outpatients with esophageal foreign body. MethodsSixty elderly outpatients who were treated for esophageal foreign body at the Endoscopy Center of Northern Jiangsu People's Hospital from September 2018 to September 2019 were selected. Those patients were randomly divided into either a control group or a conscious analgesia and sedation group (CA group) with 30 cases each using a random number table. The control group underwent analgesia with Propofol alone, while the CA group underwent short-term conscious analgesia and sedation. Comparison was made between the two groups in terms of Ramsay sedation score standard time, intraoperative hypotension and hypoxia, additional times of anesthesia, post-anesthesia resuscitation time, telephone follow-up at postoperative 24 h to assess the occurrence of uncomfortable symptoms like nausea and vomiting, patient satisfaction, and endoscopic surgeon satisfaction. ResultsThe mean time to predetermined Ramsay score in the CA group was significantly longer than that of the control group [(50.73±6.78) s vs (24.47±7.00) s, t=14.765, P＜0.001]. The incidence of intraoperative hypotension in the CA group (20.0%, 6/30) was significantly lower than that of the control group (66.7%, 20/30) (χ²=13.303, P＜0.001). Post-anesthesia resuscitation time in the CA group was significantly shorter than that of the control group [(5.63±2.61) min vs (22.63±3.73) min, t=20.472, P＜0.001]. The occurrence of postoperative discomfort symptoms in the CA group (6.7%,2/30) was significantly lower than that of the control group (26.7%,8/30) (χ²=4.32, P＜0.05). There were no significant differences in intraoperative hypoxemia, additional times of anesthesia, patient satisfaction, or endoscopic surgeon satisfaction between the two groups (P＞0.05). ConclusionRemifentanil combined with Propofol for short-term conscious analgesia and sedation can not only ensure intraoperative stability and rapid postoperative resuscitation, but also reduce postoperative uncomfortable symptoms, which is suitable for elderly outpatients with esophageal foreign body.