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目的通过对门诊大量无痛胃镜手术的观察,总结出门诊无痛胃镜的特点,最大程度的规避麻醉风险。方法 400例行无痛胃镜手术的患者,术前充分了解病情,并酌情给予阿托品和舒芬太尼,手术开始给予丙泊酚。持续观察生命体征的变化。结果全部患者皆完成无痛胃镜检查,胃镜检查完毕后患者很快苏醒,麻醉清醒后无恶性记忆。5例患者出现呼吸抑制,血氧饱和度(SpO_2)下降至90%以下经积极吸氧和面罩给氧,患者皆饱和度上升,继续完成手术;2例心率增快至135次/min;9例出现呛咳,须停止手术追加给药;1例出现返流,吸出大量胃液后手术继续。大部分手术只需一次给药量就可完成手术,只有10%的患者需追加给药量。其余患者顺利完成无痛胃镜检查。400例患者中丙泊酚剂量150ml,平均剂量120 ml。胃镜操作时间2~10 min,手术完成后2~10 min全部清醒。结论门诊无痛胃镜手术是一项高风险的工作,其特殊性要求必须短时了解患者病情,充分重做好术前的各种准备工作,应用丙泊酚短时高效的特点,完全胜任门诊无痛胃镜的麻醉,且便于管理。
Objective Through the observation of a large number of painless gastroscopic operations in clinics, the characteristics of out-patient painless gastroscope are summarized, and the maximum risk of anesthesia is avoided. Methods 400 cases of painless gastroscopy surgery patients fully understand the condition before surgery, and given atropine and sufentanil, as appropriate, started propofol surgery. Continue to observe changes in vital signs. Results All patients completed painless gastroscopy, patients quickly wake up after gastroscopy, anesthesia, no malignant memory after awake. Five patients had respiratory depression, SpO2 decreased to less than 90%. Oxygen inhalation and face mask oxygenation increased in all patients, and the operation continued. The heart rate of two patients increased rapidly to 135 times / min. Case of cough, to stop surgery additional medication; 1 case of reflux, aspiration of large amounts of gastric surgery continued. Most operations require only one dose to complete the procedure, and only 10% require additional dose. The remaining patients successfully completed painless gastroscopy. 400 patients propofol 150ml, the average dose of 120 ml. Gastroscopic operation time 2 ~ 10 min, 2 ~ 10 min after surgery is complete awake. Conclusion Outpatient painless gastroscopic surgery is a high-risk work, its particularity requires a short understanding of the patient’s condition, fully re-do a variety of preparatory work before surgery, the application of propofol short-term and efficient features, fully qualified out-patient Painless gastroscopy anesthesia, and easy to manage.