咽部表面麻醉在中深度镇静麻醉下胃镜检查中的应用价值

目的观察咽部表面麻醉在中深度镇静麻醉下胃镜检查中的应用价值。方法选择行无痛胃镜检查150例患者，根据就诊顺序随机分为两组，每组75例。人室后试验组患者予以1％丁卡因喷雾咽喉部3次，以患者出现口咽部麻木感为佳；对照组患者不进行咽喉部喷雾。所有患者静脉推注1．0mg咪达唑仑，随后静脉滴注芬太尼0．05mg，药物起效后缓慢静脉推注丙泊酚至中重度镇静（BIS：55～65）后给予镜检。操作过程中如有体动反应或BIS〉70，追加丙泊酚0．3—0．5mg／kg。观察各组血压、心率、脉搏血氧饱和度（SpO2）、丙泊酚用量以及不良反应的发生，记录患者的麻醉效果。结果试验组患者麻醉效果优59例、良15例、差1例，对照组分别为53例、19例、3例，两组比较差异无统计学意义（P〉O．05）。两组麻醉前、进镜时及退镜后SpO2、心率、平均动脉压比较差异无统计学意义（P〉0．05）。两组诱导时间、苏醒时间、丙泊酚用量比较差异无统计学意义（P〉0．05）。两组围手术期躁动、呛咳、呼吸抑制的不良事件发生情况比较差异均无统计学意义（P〉0．05）；但试验组患者表面麻醉后，咽部不适37例、恶心24例、紧张恐惧49例，显著高于对照组的0，0，12例，差异有统计学意义（P〈0．05）。结论咪达唑仑-芬太尼-丙泊酚中深度镇静麻醉复合咽部表面麻醉不能减轻胃镜检查操作中的不良反应，反而增加术前患者不适感和恶心呕吐，临床应用价值有限。

Discussion the value of topical pharyngeal anesthesia in patients undergoing painless gastrointestinal endoscopy examination

Objective To explore the value of topical pharyngeal anesthesia combined with deep sedation anesthesia in patients undergoing painless gastrointestinal endoscopy examination. Methods One hundred and fifty patients were randomly divided into test group and control group, each group 75 patients. Before the examination the patients of test group were sprayed throat 1% tetracaine three times, the patients of control group were not performed throat spray. All patients were given intravenous midazolam 1.0 mg before the examination, then all patients were given intravenous fentanyl 0.05 mg and intravenous injection of propofol when BIS was 55 - 65 ,the microscopy was given. If the patients had somatic reaction or BIS 〉 70, additional propofol 0.3 - 0.5 mg/kg. The blood pressure （BP）, heart rate （HR）, venous oxygen saturation （SpO2）, the dose of propofol and side effects were observed. Results The anesthetic effects： excellent 59 cases, mild good 15 cases, no good 1 case in test group, excellent 53 cases, mild good 19 cases, no good 3 cases in control group, there was no significant difference （P 〉 0.05）. The level of SpO2, HR, MAP before anesthesia, during operation and after operation between two groups had no significant difference（P 〉 0.05 ）. The induction time and recovery time of anesthesia, the dose of propofol between two groups had no significant difference （P 〉 0.05）. The rate of restlessness, bucking, respiratory depression between two groups had no significant difference（P 〉 0.05 ）. In test group, pharyngeal portion unwell 37 cases, nausea 24 cases, tension 49 cases, and in control group was 0,0, 12 cases, there was significant difference （P 〈 0.05 ）. Conclusions The use of deep sedation anesthesia with midazolam-fentanyl-propofol can not reduce the incidence of cough, respiratory depression and other side effects, but can increase the rate of pharyngeal portion unwell and nausea. The clinical value is limited.