笑气清醒镇静镇痛与丙泊酚静脉麻醉用于胃镜检查的临床价值比较研究

目的研究笑气化状态的诱导过程并比较笑气清醒镇静镇痛与丙泊酚静脉麻醉用于胃镜检查的安全性及有效性。方法选择2013年4月至2013年10月行胃镜检查患者400例，随机分为笑气组200例和丙泊酚组200例，记录笑气组达到笑气化状态的时间及浓度，2组患者检查前、中、后的收缩压、舒张压、心率、血氧饱和度，及药物起效时间、胃镜操作时间、镇静效果、恢复时间、留院时间、不良反应。检查结束后医生与患者填写调查问卷。结果笑气组达到笑气化状态的平均时间为（3．16±0．65）min，男性与女性无明显差异（3．16±0．71）比（3．16±0．58）min，t=0．006，P〉0．05）；达到笑气化状态的平均笑气浓度为（43．68±5．05）％，男性明显高于女性（45．30±4．99）％比（41．46±4．30）％，t=3．042，P〈0．05]。与检查前比较，丙泊酚组检查中的收缩压、舒张压、心率、血氧饱和度均明显降低（P〈0．05），而笑气组检查中的收缩压、舒张压、心率均明显升高（P〈0．05）。丙泊酚组的起效时间及操作时间比笑气组短（P〈0．05），镇静效果比笑气组更深（P〈0．05），但笑气组的恢复时间、留院时间均比丙泊酚组明显减少（P〈0．05）。检查中丙泊酚组部分患者出现低氧血症、低血压、心率过缓等不良反应，而笑气组主要不良反应为恶心、干呕等咽部刺激反应。调查问卷结果显示：笑气组的医师满意度、患者满意度、患者愿意再次接受检查的比例均低于丙泊酚组（86±3．7比96±2．6，87±2．8比98±1．2，87％比99％，P〈0．05）。结论笑气清醒镇静镇痛及丙泊酚静脉麻醉用于胃镜检查均是有效的，但前者对心肺功能影响更小更安全。准确识别笑气化状态是笑气清醒镇静镇痛成功实施的关键。重视影响笑气清醒镇静镇痛技术安全性及有效性的9个因素，对于优?

A comparitive study between conscious sedation by nitrous oxide inhalation and intravenous sedation with propofol for upper gastrointestinal endoscopy

Objective To study the induction of nitrous oxide （N2O）and to compare safety and effectiveness of conscious sedation by nitrous oxide inhalation and intravenous sedation with propofol for upper gastrointestinal（UGI） endoscopy. Methods A total of 400 patients undergoing UGI endoscopy in our hospital from April 2013 to October 2013 were randomly assigned to two groups, N2O inhalation group（ n = 200 ）and intravenous propofol group（ n = 200）. The systolic pressures, diastolic pressures, heart rates and oxygen saturation, onset time, procedure duration, degree of sedation, recovery time, length of hospital stay, complications, satisfaction ratings of doctors and patients, and the number of patients willing to accept the examination again were analyzed. Results The mean time of ideal anesthesia state for N2O was （3.16 ± 0. 65 ）min and there was no difference between the male and female（3. 16±0. 71 ）rain vs. （3. 16±0. 58） min, t =0. 006, P 〉 0. 05 ）. The mean concentration was （43.68 ± 5.05 ）%, which was higher in male than that in female （45. 3 ± 4. 99 ） % vs. （41.46 ± 4. 30 ） %, t = 3.042, P 〈 0. 05 ]. Compared with before, the systolic pressures, diastolic pressures, heart rates and oxygen saturation of patients in the propofol group significantly reduced during the procedure（ P 〈0. 05 ） ,while the same measurements excluding oxygen saturation for those in the N2O group significantly increased（P 〈 0. 05 ）. Compared with the propofol group, patients inhaling N2O had significantly shorter recovery and hospital stay time, but a longer onset time and procedure duration （P 〈 0. 05 ）. Complications that occurred in some patients of propofol group included hyoxemia, hypotension, bradycardia, while the major complication in the N2O group was nausea. The satisfaction ratings of doctors or patients and the number of patients willing to accept the examination again in N2O group were smaller than those in propofol group （ 86 ± 3. 7 vs. 96±2.6,87±2.8vs.