无痛内镜术在胃肠道疾病诊治中的应用

Clinical effects of dezocine plus propofol vs fentanyl plus propofol in painless colonoscopy

AIM: To compare the clinical effects of dezocine plus propofol vs fentanyl plus propofol in painless colonoscopy.

METHODS: One hundred and sixty-two patients who would undergo painless colonoscopy were divided into either a dezocine + propofol group (n = 83) or a fentanyl + propofol group (n = 79). They were anesthetized with dezocine plus propofol and fentanyl plus propofol, respectively. The heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), oxygen saturation (SPO₂), the total dosage of propofol, wake-up time, observation time, visual analogue scale (VAS) and adverse reactions were compared between the two groups.

RESULTS: There were no significant differences in HR, MAP, RR or SPO₂ between the two groups (P > 0.05). The wake-up time and observation time in the dezocine + propofol group were significantly shorter than those in the fentanyl + propofol group (38.53 s ± 21.35 s vs 53.56 s ± 24.84 s, 16.08 min ± 9.22 min vs 22.55 min ± 12.60 min, P < 0.05). The rates of apnea, postoperative nausea, vomiting and dizziness in the dezocine + propofol group were significantly lower than those in the fentanyl + propofol group (2.41% vs 15.19%, 2.41% vs 17.72%, 7.23% vs 15.19%, P < 0.05).

CONCLUSION: Dezocine plus propofol could achieve satisfactory anesthesia effects in painless colonoscopy and has less adverse reactions and high safety, representing a preferred way for anesthesia in painless colonoscopy.

Effects of propofol with midazolam verus lidocaine during gastroscopy in elderly patients

AIM: To compare the effects of propofol with midazolam versus lidocaine during endoscopy in elderly patients.

METHODS: Ninety-seven ASA-Ⅱ class patients were used as an experimental group. They were treated with propofol with midazolam for painless gastroscopy between July 2008 and July 2013 at our hospital. Eighty-two ASA-Ⅱ level patients who used traditional lidocaine gel pulp in painless gastroscopy were used as a control group. Age, weight, baseline blood pressure between two groups had no significant differences (P > 0.05 for all). Professional medical personnel recorded the changes in blood pressure, heart rate, oxygen saturation and adverse reactions in the examination process.

RESULTS: After the painless gastroscopy procedure, blood pressure and heart rate in the experimental group were significantly lower than those in the control group (blood pressure: 90.2 mmHg ± 2.5 mmHg vs 131.2 mmHg ± 3.4 mmHg; heart rate: 70.2 ± 1.5 vs 85.0 ± 6.4, P < 0.05). During the examination process, blood pressure and heart rate dropped initially and then rose to a stable level in the experimental group, while in the control group, blood pressure and heart rate initially increased and then decreased to a stable level. The differences were statistically significant (P < 0.05) within the two groups. Oxygen saturation between groups and within groups showed no significant differences (P > 0.05). Compared with the control group, adverse reactions in the experimental group were significantly reduced (χ² = 12.991, 142.482, 55.838, 179.000, P < 0.05). Times to wake up from anesthesia and drug elimination were relatively short in the experimental group (1.51 s ± 0.17 s, 8.21 s ± 2.32 s).

CONCLUSION: Propofol combined with midazolam in painless gastroscopy can effectively reduce the risk of cardiovascular diseases in patients and is associated with shorter times to wake up and drug elimination.

Clinical application of sedated gastrocolonoscopy versus conventional gastrocolonoscopy: an analysis of 1 800 cases

AIM: To compare the clinical costs, safety and comfortableness as well as the satisfaction degree among examinees and examiners between sedated gastrocolonoscopy and conventional gastrocolonoscopy.

METHODS: One thousand and eight hundred patients undergoing gastrocolonoscopy and 11 physicians conducting such examinations at either Zhongnan Hospital of Wuhan University or Wuhan General Hospital of Guangzhou Military Command from March 2009 to September 2009 were enrolled to fill out a questionnaire. Of all patients, 1 000 underwent conventional gastrocolonoscopy, and 800 underwent sedation gastrocolonoscopy.

RESULTS: The two groups of patients had significant differences in occupation, educational background, income level and the source of costs (all P < 0.01). There was no statistical difference in the number of patients intolerant of the examinations between the two groups (P > 0.05). Significant differences were also noted in the comfortableness and safety between the two groups (P < 0.01). Although there was no significant difference in patient's satisfaction degree between the two groups (P > 0.05), the physicians believed that conventional gastrocolonoscopy was safer than sedated gastrocolonoscopy.

CONCLUSION: Conventional gastrocolonoscopy is economic, effective and safe, and is accepted by the majority of patients. Though sedated gastrocolonoscopy is more comfortable and less painful, it has a higher price and risk. Therefore, sedated gastrocolonoscopy is suitable for patients who are unwilling to or cannot undergo conventional endoscopy. Patients who previously underwent colonoscopy prefer to accept sedated examination.