摘要
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 This study characterizes propofol＇s safety prefile and evaluates risk factors in consecutive high-risk patients, Methods All 4 027 patients undergoing a gastrocopy procedure under sedation with propofol between January 2003 to December 2004 including outpatient and inpatient were eligible for inclusion in this retrospective study. Sedation was voluntary, Demographic data and clinical features were recorded. A structured personal history, led to a 5-class risk strutification based on the criteria of the American Society of Anesthesiologists. 1 357 al risk-patients were sedated with propofol,of whom 33.7% （ 1036 ASA Ⅲ ,321 ASA Ⅳ）were matched with 2 670 consecutive patients of the same gender and age assigned to ASA classes Ⅰ and Ⅱ. Anesthetist performed all sedations by propofol dose titration while carefully monitoring arterial oxygen saturation,heart rate, and blood pressure. Results No major complications occurred among the critically ill patients. There was. however, an increased risk for a short relevant oxygen desaturation （ 〈90% ） of 4. 9% for ASA Ⅲ and Ⅳ versus 2. 7% for ASA Ⅰ and Ⅱ （P 〈0. 05）. In all cases ,increasing flow of inhaling oxygen and/or aspirating sputum was necessary. Also,a greater proportion of patients showed a 〉 or = 20% heart rate and a 〉 or = 25% mean arterial pressure decrease. Conclusion With careful monitoring, propofol sedation during gastrocopy is safe, even for high-risk patients. Considering their higher comorbidity and tendency toward oxygen desaturation, they need particularly careful monitoring.
出处
《临床消化病杂志》
2005年第6期298-300,共3页
Chinese Journal of Clinical Gastroenterology
