【摘要】目的 探讨芬太尼联合异丙酚用于食管静脉曲张套扎治疗的疗效和安全性。方法 73例肝硬化患者分为芬太尼联合异丙酚组(I组)、镇静剂组(Ⅱ组)和普通胃镜组(Ⅲ组)，共进行114例次内镜下套扎术，比较各组胃镜操作时间、视野清晰度、术中不适反应和呼吸、心率、血压、血氧饱和度变化。结果 I组胃镜操作时间明显短于Ⅲ组(P<0.05)，I组及Ⅱ组视野清晰度明显高于Ⅲ组(P<0.05)。除I组患者术中血压有一过性下降外(P<0.01)，各组的呼吸、心率、血氧饱和度无明显变化，但I、Ⅱ组术中不适反应少。结论 芬太尼联合异丙酚实行食管静脉曲张套扎术疗效良好，不适反应少。
【关键词】 芬太尼 异丙酚 食管静脉曲张 套扎
Efficacy and safety of combined administration of fentany and propofol in endoscopic variceal ligation
HUANG Wei, WANG An, LIANG Huamin, GUO Tingting, ZHEN Meilan
(Department of Gastroenterology, Zhuhai People s Hospital, Zhuhai 51900, China)
Abstract:Objective To evaluate the efficacy and safety of combined administration of fentany and propofol for endoscopic sedation in patients with esophageal varices.Methods Seventythree patients with liver cirrhosis were randomly divided into three groups: fentanylpropofol group (group I), sedation group (groupⅡ) and conventional endoscopic ligation group (group Ⅲ); 114 endoscopic ligations were performed in all patients. Operation time, legibility of visual field, respiration, heart rate, blood pressure, SPO2, and intraoperative adverse effects were compared among all groups.Results The operation time in group I was significantly shorter than that in group Ⅲ (P<0.05),but the legibility of visual field in groups I and Ⅱ was superior to that in group Ⅲ (P<0.05).The respiration, heart rate and SPO2 remained normal during operation in all groups except temporary hypotension in group I (P<0.01). The intraoperative adverse effects were fewer in groups I and Ⅱ compared with group Ⅲ.Conclusion The combined sedation of fentanyl and propofol is effective and safe in endoscopic variceal ligation.
Key words: fentanyl; propofol; esophageal varices; loop ligature
内镜下食管脉套扎术(EVL)是目前治疗和预防食管静脉曲张破裂出血的主要有效方法，危险小，成功率高;但常规胃镜检查是一种外源性刺激，可诱发机体产生应激反应，使儿茶酚胺等激素水平显著升高，引起循环系统变化，甚至诱发严重心脑血管并发症[1]。胃镜下治疗，由于操作时间长，患者痛苦大，从而产生紧张、恐惧心理，增加术中并发症的发生，甚至拒绝再次治疗。而无痛胃镜下行EVL，
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