论文部分内容阅读
目的评估异丙酚麻醉在胃镜检查中的安全性和风险因素。方法对我院2003年1月～2004年12月中门诊及住院自愿行异丙酚麻醉胃镜检查患者共4027例进行回顾性分析,按美国麻醉医师协会(ASA)的分级标准,其中ASAⅠ～Ⅱ级2070例(Ⅰ级1429例,Ⅱ级1241例)与ASAⅢ～Ⅳ级1357例(Ⅲ级1036例,Ⅳ级321例)。异丙酚的使用由麻醉师所控制,所有检查的患者均用多功能心电监测仪监测胃镜检查前、后的血氧饱和度、血压和心率的变化。结果ASAⅢ～Ⅳ级组和ASAⅠ～Ⅱ级组患者外周血氧饱和度低于90%的发生率分别为4.9%和2.7%,给予加大吸氧流量,或吸痰后部分患者得以纠正。同时降低平均动脉压和心率的发生率较高,但MAP>25%和HR>20%的发生率在ASAⅢ～Ⅳ级组却低于ASAⅠ～Ⅱ级组。结论异丙酚麻醉胃镜即使在具有高危因素的患者中也是安全可行的,但建议由麻醉师和胃肠病学家共同进行,同时在操作中应常规鼻导管吸氧,备好急救器械及药品,严密监测病人的生命指标。
Objective To evaluate the safety and risk factors of propofol anesthesia in gastroscopy. Methods A total of 4027 patients were enrolled in our hospital from January 2003 to December 2004, and 4027 patients undergoing propofol anesthesia for endoscopy were retrospectively analyzed. According to the American Society of Anesthesiologists (ASA) grading standards, ASA Ⅰ ~ Ⅱ There were 2070 cases (1429 cases of grade Ⅰ, 1241 cases of grade Ⅱ) and 1357 cases of ASA Ⅲ ~ Ⅳ (1036 cases of grade Ⅲ and 321 cases of grade Ⅳ). The use of propofol was controlled by the anesthesiologist, and all patients examined monitored changes in blood oxygen saturation, blood pressure, and heart rate before and after gastroscopy with a multifunctional ECG monitor. Results The incidences of peripheral oxygen saturation of less than 90% were 4.9% and 2.7% in ASA Ⅲ ~ Ⅳ group and ASA Ⅰ ~ Ⅱ group, respectively. At the same time, the incidence of mean arterial pressure and heart rate decreased significantly, but the incidence of MAP> 25% and HR> 20% was lower in ASA Ⅲ-Ⅳ group than in ASAⅠ-Ⅱ group. Conclusions Propofol anesthesia gastroscope is safe and feasible even in patients with high risk factors, but it is recommended that anesthesiologists and gastroenterologists work together, and the nasal catheter should be routinely oxygenated and prepared with first-aid equipment and medicines , Closely monitor the patient’s life indicators.