异丙酚复合芬太尼MAC技术在胃镜检查中的应用

Application of MAC by propofol combined with fentanyl in gastroscopy

关键词:  异丙酚  芬太尼  MAC技术  胃镜检查

Key words:  propofol  fentanyl  MAC  gastroscopy

摘要:

［目的］探讨以异丙酚复合芬太尼实施监护下麻醉管理(Monitored Anesthesia Care,MAC)技术，应用于胃镜检查中的有效性和安全性。［方法］ 520例行胃镜检查者随机分为MAC组和对照组(n=260)，对照组以2%利多卡因胶浆液行口咽表面麻醉后行胃镜检查。MAC组表麻后以芬太尼1 μg/kg静脉注射，继以异丙酚1～2 mg/s速度推注，Ramsay镇静分级4～5级后行胃镜检查，术中5～10 mg/min速度维持MAC。［结果］ MAC 组无痛率100%，其中安静入睡213例（82%），轻微肢体活动26例（10%），明显肢体活动影响操作21例（8%），清醒时间短，不良反应少，检查中生命体征平稳。对照组病例则有不同程度的口咽食道疼痛或不适，不良反应多。［结论］ 异丙酚复合芬太尼MAC技术应用于胃镜检查，镇痛镇静效果确切，安全。

Abstract:

［Objective］ To investigate the effect and safety of monitored anesthesia care（MAC）by Propofol combined with Fentanyl in gastroscopy.［Methods］ AU 520 patients attending for gastroscopy were randomly chosen and divided into control group(n=260)and MAC group(n=260).Control group underwent throat local anaesthesia by Lidocaine Hydrochloride Mucilage before normalgastroscopy. MAC group was given Fentanyl (1μg /kg) and Propofol (1～2 mg/s) intravenously after throat local anaesthesia.If the patients reached class Ⅳ～Ⅴ of Ramsay score, inserted the gastroscope，and maintained with Propofol 5～10 mg/min. ［Results］ In MAC group ,painless percentage was 100%,213 patients （82%）was sedately asleep,26 patients（10%）had low-grade body movement,21 patient（8%） had obvious body movement, awake time was short,and the vital signs were stable during gastroscopy.In control group,all patients felt throat ache or discomfort. The incidence ofbad resction in control group was higher than that in MAC group.［Conclusion］ Theapplication of MAC by Propofol combined with Fentanyl in gastroscopy is safe,comfortable and effective.