| Objective:In view of the pulmonary heart disease patients undergoing gastrointestinal endoscopy security concerns, this study by propofol combined with fentanyl or sufentanil were used in patients with pulmonary heart disease painless gastrointestinal examination, vital signs were observed and autonomy neurological changes. By contrast with the sober examination painless, comparing the effects of different opioid narcotic sedation, adverse reactions and effects on autonomic function, to evaluate the safety and mechanism, a clear drug selection and better way. Pulmonary heart disease patients get good pain relief and sedation during gastroscopy, improve the success rate and safety check and recheck improve compliance.Methods:gastrointestinal endoscopy to be done to look into the treatment of patients with pulmonary heart disease 75 cases were divided into three groups, one control group (conventional sober gastroscopy), the other two groups were selected propofol and fentanyl or sufentanil sedative painless anesthesia observe the changes in the three groups of patients vital signs and autonomic functions.75 patients, aged 50-78 years old, no allergies propofol and opioids, no liver and kidney dysfunction, no history of asthma and heart function grade 3 or less. Random (randomly) divided into 3 groups (n= 25), control group (group D), fentanyl group (F) and sufentanil group (S), single-blind test. Subjects in each group were recorded intraoperative reactions, microscopic operation time, anesthetic onset time, subjects awake and sober time, before endoscopy, intraoperative, postoperative vital signs (blood pressure, heart rate, pulse and blood oxygen saturation) and autonomic nervous system function HRV in the time domain analysis SDNN standards for all normal sinus RR interval difference within (a period of time in ms) changes in the amount of intravenous anesthetic drugs, anesthesia recovery time and intraoperative after the questionnaire.Results:Control group (group D), subject intraoperative blood pressure and heart rate increased significantly, blood oxygen saturation, SDNN decreased significantly, especially before the elderly (≥60 years) and those with poor cardiopulmonary function basis, than over surgery are significant differences (P<0.01).Comparison, a fentanyl propofol group (F) with a sufentanil propofol group (S) of subjects with adverse surgery control group (group D) reaction, less discomfort (P<0.05); vital signs, better stability, SDNN smaller changes, there was a significant difference (P <0.05); microscopy short operating time (P<0.05); significantly reduce discomfort and unbearable feelings microscopic proportions (P<0.05), the proportion without discomfort and willing to accept the microscopic review again increased significantly (P<0.05).A fentanyl propofol group (F) with a sufentanil propofol group (S group) compared with this study, "light sedation, deep pain" philosophy, but also in controlling opioid may seriously respiratory inhibitor dose equivalent amount or less. Both groups have good hemodynamic stability, response to stress is small, but the F group recovery time, recovery time is longer, and there are dizziness, drowsiness and other side effects. A comparison of two groups of surgery, anesthesia group S onset time, surgery was significantly lower body movement, oxygen saturation S can be reduced by checking patients, bradycardia, blood pressure and reduce the incidence rate is slightly higher, while SDNN changes in smaller, recovery time was significantly shorter in group F and obvious respiratory depression, rare adverse reactions, the dose of propofol S group also less than F group.Conclusion:The present study was to compare painless gastroscopy with sobriety, compared to propofol combined with fentanyl or sufentanil were painless gastrointestinal examination in patients with pulmonary heart disease observed sedation effects, adverse reactions, vital signs and autonomy neurological changes. Proved that the use of "light sedation, deep pain" philosophy, propofol can cause safety in severe respiratory depressant amount less opioids pulmonary heart patient sedation gastroscopy painless, comfort, recheck compliance They were higher than sober examination. You can see a small amount of equivalent doses of sufentanil than fentanyl for painless gastroscopy in elderly patients, especially in patients with pulmonary heart disease is more favorable.It should be stressed that security for pulmonary heart patients undergoing gastrointestinal endoscopy is painless, strict preoperative evaluation before preparing and psychological care, preoperative pre-oxygenation, gentle intravenous speed, tight intraoperative monitoring process, improve postoperative recovery care are highly significant. |
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