瑞芬太尼复合丙泊酚麻醉在胃镜下食管静脉曲张治疗术中的应用-现代医学

瑞芬太尼复合丙泊酚麻醉在胃镜下食管静脉曲张治疗术中的应用

单位：南京鼓楼医院麻醉手术科, 江苏南京 210008

分类号：R571.3;R614.2

出版年·卷·期（页码）：2018·46·第十一期（1275-1278）

摘要：

目的：评估不同剂量瑞芬太尼和丙泊酚镇静镇痛组合对胃镜下行食管静脉曲张硬化剂治疗术（EVS）和（或）套扎术（EVL）患者的影响。方法：A组，丙泊酚复合小剂量瑞芬太尼镇静镇痛下对30例非食管静脉曲张患者行胃镜精查；B组，瑞芬太尼复合小剂量丙泊酚镇静镇痛下对30例食管静脉曲张患者行EVS和（或）EVL；C组，丙泊酚复合小剂量瑞芬太尼镇静镇痛下对30例食管静脉曲张患者行EVS和（或）EVL。记录3组麻醉诱导前（T₀）、麻醉诱导后（T₁）、操作前段（T₂）、操作后段（T₃）、操作结束后5 min（T₄）的SBP、DBP、SpO₂、HR，同时记录麻醉药物用量、升压药物用量、患者体动次数、患者恢复时间、患者满意度及术后并发症等。结果：与T₀相比，3组在T₁、T₂、T₃时点SBP、DBP、HR都有降低（P<0.05）；与A、B组相比，C组在T₁、T₂、T₃时点SBP、DBP都有降低（P<0.05）。麻醉药物用量C组少于A组，升压药物用量C组多于A组和B组（P<0.05），恢复时间C组长于A组和B组（P<0.05）。患者体动次数B组高于A组和C组。结论：瑞芬太尼复合丙泊酚静脉麻醉能较好地应用于胃镜下治疗食管静脉曲张，而丙泊酚复合小剂量瑞芬太尼对食管静脉曲张患者围术期的血压影响较大，须使用血管活性药物来维持血流动力学的稳定。

Objective:To evaluate the effect of combined administration of different doses of propofol and remifentanil for intravenous anesthesia in patients undergoing endoscopic variceal sclerotherapy(EVS), and/or endoscopic variceal ligation(EVL). Methods:Group A included 30 patients with non-esophageal varices injected with propofol and low-dose remifentanil under gastroscope. Sixty patients with esophageal varices were divided into group B and group C who performed EVS, and/or EVL. Group B was injected with remifentanil and low-dose propofol, while Group C propofol and low-dose Remifentanil. Systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR) and blood oxygen saturation(SpO₂) were recorded at the time before anesthesia induction (T₀), the time after anesthesia induction(T₁), the time of early stage in therapy(T₂), the time of later stage in therapy(T₃), 5 minutes after therapy(T₄). The amount of anesthetics, the amount of booster, the times of patient's body movement, the level of patient satisfaction, the patient recovery time, and the postoperative complications of the three groups were recorded simultaneously. Results:Compared with T₀, SBP, DBP and HR reduced at T₁, T₂, T₃ in all the three groups. Compared with Group A and Group B, SBP, DBP and HR reduced at T₁, T₂, T₃ in Group C. At the same time, the anesthetics dosage of group C was less than that of group A, the booster dosage was more than that of group A and group B, the recovery interval of group C was longer than group A and group B (P<0.05), the number of body movements of group B was higher than that in group A and group C. Conclusion:Combined administration of propofol and remifentanil can better treat esophageal varices under gastroscope, but the use of propofol combined with low-dose of remifentanil has a great influence on the perioperative blood pressure of patients with esophageal varices, and vasoactive drugs should be used to maintain the stability of hemodynamic.

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