| 陈 莺,张 毅,李妍蔚,黄超,徐雷鸣.笑气与异丙酚在胃肠镜检查中应用的临床分析和护理[J].上海护理,2014,14(6): |
| 笑气与异丙酚在胃肠镜检查中应用的临床分析和护理 |
| Evaluation of the efficiency of nitrous oxide in gastrointestinal endoscopy and its nursing care(Xinhua Hospital, Shanghai Jiaotong University,shanghai 200092,china)CHEN Ying, ZHANG Yi, LI Yanwei, HUANG Chao, XU Lei-ming |
| DOI： |
| 中文关键词: 笑气 异丙酚 胃肠镜 护理 |
| 英文关键词:Nitrous oxide Propofol Gastrointestinal endoscopy Nuresing care |
| 基金项目:上海交通大学医学院附属新华医院院级课题(12YJ21) |
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| 中文摘要: |
| 摘要：目的 探讨笑气(Nitrous Oxide，N2O)吸入与丙泊酚（Propofol,Pro）静脉注射用于无痛胃肠镜检查时的镇静镇痛效果比较及护理。方法 将2012年5月至2013年10月我院笑气吸入内镜受检者317例（I组，其中胃镜为Ia组，肠镜为Ib组)和丙泊酚静脉注射内镜受检者463例（II组，其中胃镜为IIa组，肠镜为IIb组)进行对照分析。笑气组给予吸入笑氧混合气体至患者有头晕或睡意后开始镜检。异丙酚组静脉推注异丙酚至患者睫毛反射消失后开始镜检。观察记录两组受检者检查前、中、后的血压（BP）、心率（HR）、指脉血氧饱和度（SPO2），术中的不适反应，胃肠镜操作时间，麻醉药物起效时间、清醒时间，并进行术后问卷调查。结果II组与I组相比，术中BP、SPO2均有明显下降，两组术中与术前BP、SPO2的差值比较差异有统计学意义(p <0.05)，其中II组有77例受检者出现收缩压（Systolic Blood Pressure，SBP）<80mmHg，86例受检者出现SPO2低于95%，而I组仅有1例受检者出现SBP<80mmHg，所有受检者术中SPO2>95%，差异有统计学意义(p<0.05)；Ia组HR上升幅度高于IIa组(p<0.05)，Ib组HR变化与IIb组比较差异无统计学意义(p>0.05)；II组胃肠镜操作时间均较I组缩短(p<0.05)，术中不适反应少(p<0.05)，术后复检接受度高于I组(p<0.01)；但II组恢复清醒时间长，与I组比较差异有统计学意义(p<0.05)。结论 与异丙酚静脉麻醉比较，笑气吸入血流动力学更稳定，对呼吸无抑制作用，术后恢复时间短；术中舒适程度和术后复检接受度静脉麻醉较笑气吸入高；对静脉麻醉有禁忌症的患者来说，笑气吸入是镇静镇痛较好的选择，规范的护理有助于提高其有效性和安全性。 |
| 英文摘要: |
| EVALUATION OF THE EFFECT AND SECURITY OF NITROUS OXIDE AND PROPOFOL lN GASTROINTESTINAL ENDOSCOPY AND THEIR NURSING CARE（Xinhua Hospital, Shanghai Jiaotong University，shanghai 200092,china）
CHEN Ying, ZHANG Yi, LI Yanwei, HUANG Chao, XU Lei-ming
Objective：.To compare the sedative and analgesic efficiency and security between Nitrous oxide (N2O) and Propofol in gastrointestinal endoscopy.Methods：317 patients who chose to receive inhaled nitrous oxide were in group I (patients undergoing gastroscopy were Ia, undergoing colonoscopy were Ib). 463 patients who chose to receive intravenous propofol were in group II (patients undergoing gastroscopy were IIa , undergoing colonoscopy were IIb). In group I, the operation started when patients felt light-headed or sleepy; in group II, the operation started when eyelash reflex of patients disappeared. The variation of blood pressure(BP)，heart rate(HR)，pefipheral oxygen saturation(SPO2), discomfort of patients during the operation, duration of the procedure, the onset and recovery time of anesthesia were observed, and a questionnaire survey were carried on all the patients after the operation.Results: BP and SPO2 during the procedure decreased significantly in both groups, compared with those before the procedure (p<0.05 for both). In group II, there were 77 patients’ SBP were lower than 80mmHg, and 86 patients’ SPO2 were lower than 95%; in group I, only one patient had a less than 80mmHg SBP, and none of them had less than 95% SPO2 (p<0.05). Increase range of HR in group Ia was higher than in IIa (p<0.05), and there were no difference of HR between group Ib and group IIb (p>0.05). Group II had shorter operation time (p<0.05) and less discomfort (p<0.05), and patients were more willing to undergo reexamination under the same circumstances (p<0.01). However, the recovery time in group II is longer than that in group I (p<0.05).Conclusion: Compared with intravenous anesthesia of propofol, inhalation anesthesia of nitrous oxide has steadier haemodynamics and shorter recovery time, without respiratory depression, however, has lower comfort level and receptance of reexamination. To patients who are unsuitable for intravenous anesthesia, inhalation anesthesia of nitrous oxide would be a better choice and normative nursing care is essential for its effectiveness and safety. |
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