胃镜检查时丙泊酚对肥胖患者的影响及应对方法(1)
【摘要】 目的：探讨胃镜检查时丙泊酚对肥胖患者的影响及应对方法。方法：选取2017年
1-3月在本院内镜中心检查的肥胖患者80例，将其随机分为对照组和观察组，每组各40例。两组均采用静脉注射丙泊酚1～2 mg/kg，咪达唑仑0.03 mg/kg的麻醉方法，对照组给予常规护理，观察组给予针对性护理，比较两组患者的麻醉期间各指标、不良反应、不同时点血液动力学指标变化。结果：观察组胃镜经咽时、镜检时、镜检后5 min的HR、MAP、SpO2均较对照组控制平稳，比较差异均有统计学意义(P<0.05)；观察组入睡时间、苏醒时间、正常行走时间、丙泊酚总用量均明显低于对照组，比较差异均有统计学意义(P<0.05)；观察组不良反应发生率明显低于对照组，比较差异有统计学意义(P<0.05)。结论：肥胖患者左心室容量负荷较大，采用丙泊酚麻醉时容易出现SpO2下降，引发不良反应，采用针对性护理后能有效平稳麻醉期间各项血流动力学指标，降低不良反应发生率，减少丙泊酚用量，提高苏醒质量。
【关键词】 胃镜检查； 丙泊酚； 肥胖患者； 影响及应对方法
【Abstract】 Objective：To investigate the effects and coping methods of Propofol on obese patients in gastroscopy.Method：80 obese patients were examined by endoscopy center in our hospital from January to March 2017 were selected，they were randomly divided into observation group and control group，40 cases in each group.They were given intravenous anesthesia with Propofol 1-2 mg/kg and midazolam 0.03 mg/kg，control group was given conventional nursing，and observation group was given targeted nursing，during anesthesia of each index，adverse reactions and different point hemodynamic index changes of two groups were compared.Result：The levels of HR，MAP and SpO2 in observation group were more stable than those of control group when the gastroscope was taken at the time of swallowing，microscopic examination and 5 min after the examination，the differences were statistically significant(P<0.05).The sleeping time，recovery time，normal walking time and total amount of Propofol in observation group were significantly lower than those of control group，the differences were statistically significant(P<0.05).The incidence of adverse reactions in observation group was significantly lower than that of control group，the difference was statistically significant(P<0.05).Conclusion：The left ventricular volume load of obese patients was larger，easy to appear SpO2 decline when using Propofol anesthesia，cause adverse reactions，after targeted nursing the hemodynamic indexes can be effectively and smoothly maintained during anesthesia，reduce the incidence of adverse reactions，reduce the dosage of propofol，improve the quality of awakening.
【Key words】 Gastroscopy； Propofol； Obese patients； Effects and coping methods
First-author’s address：The Fifth Affiliated Hospital SUN YAT-SEN University，Zhuhai 519000，China
doi：10.3969/j.issn.1674-4985.2017.31.013
胃镜检查是临床常用的消化系统检查方式，其具有侵入性特點，使患者常伴有明显喉部不适及心理恐惧。近年来，随着无痛胃镜的普及，通过对患者进行静脉麻醉，使整个过程处于无感知状态，术后也无应激性回忆，受到了患者的普遍欢迎[1-2]。但对肥胖患者来说，其肺-胸顺应和肺泡通气量较体重正常者要低，而丙泊酚对心血管功能及呼吸具有一定抑制作用，且用量越大抑制作用越明显[3]。因此，肥胖患者采用无痛胃镜术具有一定的危险性，需给予针对性的护理干预，以减少术中血流动力学的波动，降低不良反应发生[4]。本研究分析胃镜检查时丙泊酚对肥胖患者的影响以及采用针对性护理的效果，现报道如下。, http://www.100md.com(罗美娟 张丽华)
1-3月在本院内镜中心检查的肥胖患者80例，将其随机分为对照组和观察组，每组各40例。两组均采用静脉注射丙泊酚1～2 mg/kg，咪达唑仑0.03 mg/kg的麻醉方法，对照组给予常规护理，观察组给予针对性护理，比较两组患者的麻醉期间各指标、不良反应、不同时点血液动力学指标变化。结果：观察组胃镜经咽时、镜检时、镜检后5 min的HR、MAP、SpO2均较对照组控制平稳，比较差异均有统计学意义(P<0.05)；观察组入睡时间、苏醒时间、正常行走时间、丙泊酚总用量均明显低于对照组，比较差异均有统计学意义(P<0.05)；观察组不良反应发生率明显低于对照组，比较差异有统计学意义(P<0.05)。结论：肥胖患者左心室容量负荷较大，采用丙泊酚麻醉时容易出现SpO2下降，引发不良反应，采用针对性护理后能有效平稳麻醉期间各项血流动力学指标，降低不良反应发生率，减少丙泊酚用量，提高苏醒质量。
【关键词】 胃镜检查； 丙泊酚； 肥胖患者； 影响及应对方法
【Abstract】 Objective：To investigate the effects and coping methods of Propofol on obese patients in gastroscopy.Method：80 obese patients were examined by endoscopy center in our hospital from January to March 2017 were selected，they were randomly divided into observation group and control group，40 cases in each group.They were given intravenous anesthesia with Propofol 1-2 mg/kg and midazolam 0.03 mg/kg，control group was given conventional nursing，and observation group was given targeted nursing，during anesthesia of each index，adverse reactions and different point hemodynamic index changes of two groups were compared.Result：The levels of HR，MAP and SpO2 in observation group were more stable than those of control group when the gastroscope was taken at the time of swallowing，microscopic examination and 5 min after the examination，the differences were statistically significant(P<0.05).The sleeping time，recovery time，normal walking time and total amount of Propofol in observation group were significantly lower than those of control group，the differences were statistically significant(P<0.05).The incidence of adverse reactions in observation group was significantly lower than that of control group，the difference was statistically significant(P<0.05).Conclusion：The left ventricular volume load of obese patients was larger，easy to appear SpO2 decline when using Propofol anesthesia，cause adverse reactions，after targeted nursing the hemodynamic indexes can be effectively and smoothly maintained during anesthesia，reduce the incidence of adverse reactions，reduce the dosage of propofol，improve the quality of awakening.
【Key words】 Gastroscopy； Propofol； Obese patients； Effects and coping methods
First-author’s address：The Fifth Affiliated Hospital SUN YAT-SEN University，Zhuhai 519000，China
doi：10.3969/j.issn.1674-4985.2017.31.013
胃镜检查是临床常用的消化系统检查方式，其具有侵入性特點，使患者常伴有明显喉部不适及心理恐惧。近年来，随着无痛胃镜的普及，通过对患者进行静脉麻醉，使整个过程处于无感知状态，术后也无应激性回忆，受到了患者的普遍欢迎[1-2]。但对肥胖患者来说，其肺-胸顺应和肺泡通气量较体重正常者要低，而丙泊酚对心血管功能及呼吸具有一定抑制作用，且用量越大抑制作用越明显[3]。因此，肥胖患者采用无痛胃镜术具有一定的危险性，需给予针对性的护理干预，以减少术中血流动力学的波动，降低不良反应发生[4]。本研究分析胃镜检查时丙泊酚对肥胖患者的影响以及采用针对性护理的效果，现报道如下。, http://www.100md.com(罗美娟 张丽华)