作者：李萌萌，张英民, 张锦荣, 郝建华 【关键词】 静脉麻醉 Clinical observation on the anesthetic effect of propofol during gastrointestinal endoscopy 【Abstract】 AIM: To observe the anesthetic effect and safety of propofol during gastrointestinal endoscopy. METHODS: Six hundred and fiftyeight cases receiving gastrointestinal endoscopy were enrolled in this prospective study and were randomized into 3 groups: group P ［228 cases received only propofol （1-1.5 mg/kg） iv］, group LEP ［200 cases received lidocaine 20 mg and ephedrine 6 mg followed with propofol （1-1.5 mg/kg） iv］ and group C as control ［230 cases has endoscopy routinely and consciously with no anesthetic whatever］. The BP, HR and SpO2 were monitored at pre, during and 5 min after endoscopy and the pain of injection, endoscopy time, awake time and satisfaction degree were recorded. RESULTS: As compared with those preendocsopy, the greatest changes of HR and BP in group P and C during endoscopy decreased by 20.0%-30.0% or increased by 10.0%-30.0% respectively. The changes of HR and BP in group LEP were much lesser, with the BP decreasing by 3.0% and HR increasing by 7.0%. There was significant difference between group LEP and group P and C（P<0.05）. The pain during administration of propofol was more severe in group P (185 cases, 81.5%) than in group LEP (28 cases, 14.0%)（P<0.05）. CONCLUSION: Administration of propofol combined with a little dosage of lidocaine and ephedrine in advance is beneficial for gastrointestinal endoscopy. This method is safe and feasible for rapid onset of sedation with minimal cardiovascular responses. This method also reduces the pain of injection. 【Keywords】 propofol; intravenous anesthesia; gastrointestinal endoscopy 【摘要】 目的: 观察胃肠镜检查术中异丙酚iv麻醉的效果及安全性. 方法: 将658例接受胃肠镜检查的患者随机分为异丙酚组（P组，228例，单纯iv异丙酚1~1.5 mg/kg麻醉）、给予利多卡因及麻黄碱后再行异丙酚iv麻醉组（LEP组，200例，给予利多卡因20 mg及麻黄碱6 mg后行异丙酚iv麻醉）、常规组（C组，230例，常规操作）. 记录3组检查前、中及检查结束后5 min的心率(HR)、血压(SBP/DBP)、脉搏血氧饱和度(SpO2)、操作时间、是否完成检查、患者的苏醒时间、满意度及不良反应. 结果: P组和C组检查中血压，心率变化最大时比检查前降低或升高20.0%~30.0%和10.0%~30.0%. LEP组变化较小，血压仅降低3.0%，心率增加7.0%，与P,C组相比具有统计学差异（P<0.05）. P组患者主诉有血管刺激症状185例，占81.1%，而LE组患者仅28例，占14.0%，具有统计学差异（P<0.05）. 结论: 在胃肠镜检查时应用异丙酚iv可达到满意的麻醉效果. 麻醉前给予小剂量利多卡因及麻黄碱可明显减弱异丙酚的心血管反应. 【关键词】 异丙酚；静脉麻醉；胃肠镜 0引言 胃肠镜检查是诊断和治疗消化系统疾病的常用方法，由于检查的侵入性不良刺激及心血管反应，给患者带来一定的痛苦和危害，甚至诱发心血管意外. 近年来，应用适当的麻醉方法可缓解患者的痛苦，减轻心血管反应，防止不良反应的发生. 其中异丙酚静脉麻醉是目前最常用的方法之一，但由于异丙酚的注射痛及对呼吸、循环的抑制，同样给患者带来一定的风险. 为了提高麻醉的安全性，我院对拟实施胃肠镜检查的患者进行随机、双盲、对照研究，旨在寻找一种更加安全可行的无痛胃肠镜麻醉给药方法. 1对象和方法 1.1对象 选择拟在我院行胃肠镜检查的患者658例，根据美国麻醉学会（ASA）进行分级，依患者要求，随机分为单纯异丙酚iv麻醉组（P组）228例；给予利多卡因及麻黄碱后再行异丙酚iv麻醉组（LEP组）200例；以及常规操作组(C组)230例. 接受无痛操作的患者均需在麻醉知情同意书上签字. 1.2方法 接受无痛胃肠镜检查的患者建立静脉通道，P组在检查前，缓慢iv异丙酚1~1.5 mg/kg，待患者睫毛反射消失，开始进行检查. 检查过程中根据体动情况，按需追加异丙酚，一般追加10~30 mg/次. 当胃镜到达十二指肠球部或肠镜到达回盲瓣时不再追加药物. LEP组先给予利多卡因20 mg及麻黄碱6 mg，再行异丙酚iv麻醉，方法同上. 检查中当血压降低至基础值的30%时，给予麻黄碱6~10 mg. 心率低于60次/min，酌情给予阿托品0.2~0.5 mg. C组则进行常规操作. 所有患者在检查过程中保持吸氧（3 L/min），记录检查前、中及结束后
