摘要
目的探讨监测麻醉管理(monitored anesthesia care,MAC)应用于小肠镜检查的可行性。方法行小肠镜检查病人164例,随机分为两组,MAC组80例,对照组84例,2组病人检查前30min分别给予阿托品0.5mg肌注。MAC组给予力月西0.05～0.08mg/kg,芬太尼0.05～0.10mg,丙泊酚1.0～1.5mg/kg缓慢静脉注射,待病人睫毛反射消失后开始小肠镜检查,术中用丙泊酚3～6mg/(kg·h)维持。检查过程中视检查时间长短及病人反应适当追加芬太尼0.05mg/次。对照组常规进行小肠镜检查。两组病人均予吸氧,检查过程中每5min监测血压、心率、血氧饱和度和呼吸。行Ramsay和OAA/S(the Observers' Assessment of Alertness/Sedation Scale)评分,记录小肠镜操作时间及清醒时间(检查结束至呼之睁眼)。检查结束后观察半小时,询问病人有无头晕、嗜睡、怠倦等不适,病人对检查过程的感受(难以忍受、明显不适、轻微不适、无不适)。结果MAC组病人均顺利完成结肠镜检查,100%的病人整个检查过程中病人安静,无不适,均对检查过程无记忆。对照组病人有呕吐(65.4%)、躁动(79.7%)、腹部胀痛(31.5%),MAC组检查时间明显短于对照组。对照组检查中血压明显升高,心率增快。结论MAC用于小肠镜检查可以显著减轻病人的不适,安全有效,取得良好的临床效果。
[Objective] To approach the feasibility of applying the monitored anesthesia care technique in small intestinal endoscopy. [Methods] 164 patients under small intestinal endoscopy were randomly divided into two groups： A MAC group （n =80） and B control group （n =84）. Each patients of the two groups was given atropine 0.5 mg i.m at 30 minutes before examination. The patients of MAC group were intravenous injecting Midazolam （0.05- 0.08 mg/kg）, Fentanyl （0.05-0.10 mg） and propofol （3-6 mg/kg.h） slowly, and they did not receive small intestinal endoscopy until their lash reflex disappeared, then pumped propofol （3 -6 mg/kg.h） during examination, and were boosted Fentanyl 0.05 mg each time properly during examination according to the time of examination and their responses. The patients of control group were received examination routinely. All the patients were inhalating oxygen through nasal catheter and monitored Bp, HR, SpO2, and R every five minutes during examination. Applying Ramsay and the observers＇ assessment of alertness/sedation scale, record the operating time of the small intestinal endoscopy and the time from the examination to the patients opening their eyes. Observe for 30 minutes after examination, inquire the patients whether they felt dizziness, drowsiness, tiredness or not and their feeling of examination （unbearable, uncomfortable obviously, uncomfortable slightly and comfortable）. [Results] All patients of MAC group completed the small intestinal endoscopy successfully, and none felt uncomfortable and they were calm during the examination, and they had no memory of the examination. The patients of control group were vomiting（65.4%）, restless （79.7%） and abdominal distension and pain（31.5%）. The time of examination of MAC group was shorter than that of control group obviously. The blood pressure and heart rate of the patients of control group stepped up obviously during examination. [Conclusion] MAC applying to small intestinal endoscopy can ease patients＇ complaint significantly. It is safe, effective and with good clinical effect.
出处
《中国内镜杂志》
CSCD
北大核心
2007年第10期1079-1081,共3页
China Journal of Endoscopy
关键词
丙泊酚
MAC
小肠镜
propofol
MAC
small intestinal endoscopy
