【摘要】 目的观察不同剂量芬太尼复合丙泊酚用于老年心功能不全患者无痛胃镜检查的有效性和安全性。方法选取在消化内镜中心行常规胃镜检查的心功能不全(Ⅱ级及以上)患者60例,随机分成单纯丙泊酚组(P组,n=20)、1μg/kg芬太尼复合丙泊酚组(F1组,n=20)、2μg/kg芬太尼复合丙泊酚组(F2组,n=20),观察各组术中血压(NBP)、心率(HR)、脉搏血氧饱和度(SpO2)、丙泊酚用量、术中体动、术后苏醒时间、定向力恢复时间及低血压、呼吸抑制、恶心、呕吐等并发症的发生率。结果 P组丙泊酚用量明显大于F1、F2组(P<0.05);F2组的体动例数明显少于F1、P组(P<0.05);P组患者检查后苏醒时间最长,其次为F1组,F2组苏醒时间最短,三组苏醒时间差异有统计学意义(P<0.05);三组患者的定向力恢复时间差异无统计学意义(P>0.05);P、F1组患者在诱导后MAP和HR下降弧度显著大于F2组(P<0.05),但F1组与P组差异无统计学意义(P>0.05);P、F1、F2组患者分别出现4、2、1例呼吸抑制,经面罩给氧后很快恢复,差异无统计学意义(P>0.05);未发现严重恶心、呕吐等其他不良反应。结论心功能不全患者无痛胃镜检查予2μg/kg芬太尼可明显减少丙泊酚剂量,生命征平稳,不影响苏醒和定向力的恢复,安全可靠。更多还原

【Abstract】 Objective To observe the effects and security of painless gastroscopy after nesthesia with different fentanyl doses combined with propofol used in elderly patients with cardiac dysfunction. Methods 60 patients with cardiac dysfunction( Ⅱ level and above) whom were taken digestive endoscopy were randomly divided into three groups:pure propofol group(group P,n=20),1 μg/kg fentanyl combined with propofol group(group F1,n=20),2 μg/kg fentanyl combined with propofol group(group F2,n=20).Intraoperative blood pressure(NBP),heart rate(HR),pulse oximetry(SpO2),propofol dosage,intraoperative body movement,postoperative recovery time and recovery time orientation,hypotension,breathing inhibition,the incidence and complications of nausea and vomiting were observed and recorded. Results The propofol dosage of group P was significantly greater than that of group F1and F2(P<0.05);the body movement cases of group F2were significantly less than that of group F1and group P(P<0.05);the awakening time of group P after checking was longest,followed by group F1,group F2,the difference were all statistically significant(P<0.05);the differences of orientation recovery time in the three groups was not statistically significant( P>0.05);MAP and HR of group P,F1after induction decreased significantly larger than that of group F2(P<0.05),but the difference of group F1and group P was not statistically significant(P>0.05).There were 4,2,1 cases with respiratory depression in group P,group F1and group F2,and they were recover soon after oxygen masks(P>0.05).Three was no severe nausea and vomiting or other adverse reactions found in the groups. Conclusion With the doses of 2 μg/kg fentanyl on painless gastroscopy in cardiac insufficiency patients can significantly reduce the propofol dosage,keeps vital signs stable,and don ′t affect the recovery of awakening and orientation,it is safe and reliable.更多还原