瑞芬太尼在亚清醒状态下无痛胃镜中的应用

目的研究瑞芬太尼伍用小剂量异丙酚在亚清醒状态下完成无痛胃镜检查的可行性和优越性。方法选择ASAⅠ~Ⅱ级,年龄16~65岁,门诊胃镜检查患者200例,随机分成麻醉组(M)和亚清醒组(Q)各100例。M组实施方案:先静注瑞芬太尼0.5μg/kg,再注射异丙酚致患者入睡呼唤不能睁眼开始检查操作;Q组先注射瑞芬太尼1.0~1.5μg/kg,再注射异丙酚0.3~0.6 mg/kg,使患者保持在亚清醒状态(能配合指令动作),1.0~1.5 min后开始检查。观察两组患者术中操作情况、呼吸和循环的变化、术后恢复情况及药物用量。结果两组患者均能接受和顺利完成检查,恶心、呕吐的发生率均低且两组无显著性差异(P>0.05);两组呼吸暂停的发生率都较高(P>0.05),但Q组低氧血症的发生率明显低于M组(P<0.05);两组心动过缓的发生率都较高(P>0.05),但Q组低血压的发生率明显低于M组(P<0.05);Q组苏醒时间、离开恢复室时间明显少于M组(P<0.05);Q组异丙酚的用量明显少于M组(P<0.05)、瑞芬太尼用量明显多于M组(P<0.05),但综合经济指标Q组明显优于M组(P<0.05)。结论瑞芬太尼在亚清醒状态能够完成无痛胃镜检查,并具有呼吸循环干扰轻、术后恢复快、工作效率高、药物成本低等优点。

Application of Remifentanil during painless gastroscopy in the sub-conscious condition

Objective To investigate the viability and advantage of an IV Remifentanil combined with low-dose Propofol during painless gastroscopy in the sub-conscious condition.Methods 200 patients,ASA Ⅰ～Ⅱ,aged 16～65 undergoing clinic gastroscopy were randomly divided into two groups,anesthesia group(M,n=100) and sub-conscious group(Q,n=100).The patients in M group received an Ⅳ infusion of Remifentanil 0.5 μg/kg and then Propofol were induced to sleep and no reaction to call out,then the examination began;The patients in Q group received an IV infusion of Remifentanil 1.0～1.5 μg/kg and Propofol 0.3～0.6 mg/kg,they were kept in the sub-conscious condition(following the instruction),the examination began after 1.0～1.5 min.The changes of respiration and circulation,operation postoperative recovery and drug dosage in the two groups were observed.Results All of two groups accepted and completed examination successfully,incidence of nausea and vomiting were low,and there was no significant differecence between two groups(P>0.05),incidence of apnea and bradycardic in two groups were higher(P<0.05),but incidence of hyoxemia and hypotensive in Q were obviously lower than that in M(P<0.05).Revival time and the interval in recovery room of Q were obviously fewer than that of M(P<0.05).Dosage of Propofol in Q was significantly fewer than that in M,dosage of Remifentanil in Q obviously loas fewer than that in M(P<0.05),but comprehensive ecnomic index in group Q obviously surpass that in group M(P<0.05).Conclusion Remifentanil could complete the painless gastroscopy in the sub-conscious condition with the advantage of less disturbance to respiration and circulation,higher work efficiency,faster postoperation recovery and low cost of drug.