阅读说明：本技术 一种保护胃镜患者神经功能的麻醉方法 (Anesthesia method for protecting nerve function of gastroscope patient ) 是由 杨川 于 2020-05-11 设计创作，主要内容包括：本发明公开了一种保护胃镜患者神经功能的麻醉方法,属于麻醉方法技术领域,对照组：NS+异丙酚1mg/kg；芬太尼组：芬太尼0.8ug/kg+异丙酚1mg/kg；瑞芬太尼组：瑞芬太尼0.5ug/kg+异丙酚1mg/kg；舒芬太尼组：舒芬太尼0.08ug/kg+异丙酚1mg/kg；纳布啡组：纳布啡0.10mg/kg+异丙酚1mg/kg,按胃镜检查患者体重算出药物剂量后,各组均用0.9％氯化钠注射液稀释成1ml/kg,并编排注药顺序,由专人按照预定药物注射顺序并根据秒表将前两种药物注射速度分别控制为60s,间隔注药时间为60s,连续注入第3种药物,异丙酚的推注速度1ml/6s,待睫毛反射消失后开始进行胃镜检查,术中体动时酌情追加异丙酚0.5-1mg/kg,术中脉率低于50次/分,静脉阿托品,收缩压低于基础值30％,静注麻黄素,SPO2低于90％,面罩辅助呼吸。(The invention discloses an anesthesia method for protecting the nerve function of a gastroscope patient, which belongs to the technical field of anesthesia methods and comprises the following steps: NS + propofol 1 mg/kg; fentanyl group: fentanyl 0.8ug/kg + propofol 1 mg/kg; remifentanil group: remifentanil 0.5ug/kg + propofol 1 mg/kg; sufentanil group: sufentanil 0.08ug/kg + propofol 1 mg/kg; nalbuphine group: nalbuphine 0.10mg/kg + propofol 1mg/kg, after calculating the drug dose according to the weight of a patient undergoing gastroscopy, diluting each group to 1ml/kg by using 0.9% sodium chloride injection, arranging a drug injection sequence, controlling the injection speeds of the first two drugs to be 60s respectively by a special person according to a preset drug injection sequence and a stopwatch, continuously injecting the 3 rd drug with the injection speed of 1ml/6s of the propofol, starting gastroscopy after the eyelash reflex disappears, and adding propofol 0.5-1mg/kg when the patient moves in the operation, wherein the intra-operative pulse rate is lower than 50 times/min, intravenous atropine has the systolic pressure lower than the basic value of 30%, ephedrine is statically injected, SPO2 is lower than 90%, and mask assisted respiration.)

1. An anesthesia method for protecting the nerve function of a gastroscope patient is characterized in that: the method comprises the following steps:

step 1: the 1000 patients screened according to the standard are randomly divided into five groups by a computer, and each group comprises 200 patients;

step 2: control group: NS + propofol 1 mg/kg; fentanyl group: fentanyl 0.8ug/kg + propofol 1 mg/kg; remifentanil group: remifentanil 0.5ug/kg + propofol 1 mg/kg; sufentanil group: sufentanil 0.08ug/kg + propofol 1 mg/kg; nalbuphine group: nalbuphine 0.10mg/kg + propofol 1 mg/kg;

and step 3: after the medicine dosage is calculated according to the weight of a patient subjected to gastroscopy, each group is diluted to 1ml/kg by 0.9 percent sodium chloride injection, and the medicine injection sequence is arranged;

and 4, step 4: respectively controlling the injection speeds of the first two medicines to be 60s by a specially-assigned person according to a preset medicine injection sequence and a stopwatch, and controlling the time of injecting the medicines at intervals to be 60 s;

and 5: continuously injecting a 3 rd drug, wherein the injection speed of propofol is 1ml/6s, and performing gastroscopy after eyelash reflex disappears;

step 6: when the patient moves in the operation, 0.5-1mg/kg of propofol is added according to the condition, the pulse rate in the operation is lower than 50 times/min, atropine is intravenously injected, the systolic pressure is lower than the basic value by 30%, ephedrine is injected statically, SPO2 is lower than 90%, and the mask assists breathing;

and 7: evaluation of neurological function, secondary index, intraoperative complication, effectiveness and three-party satisfaction evaluation are performed after observation of gastroscopy.

2. The anesthesia method of claim 1, wherein the at least one of the following: the method adopts the principles of random, double-blind, contrast and multi-center clinical experiments and strictly executes double-blind, and specially-assigned persons are responsible for accurate medicine dispensing.

3. The anesthesia method of claim 1, wherein the at least one of the following: wherein the injection sequence in the step 3 is arranged to be opioid, propofol and 0.9% sodium chloride injection, and the dispensing person does not participate in the administration and data collection work.

4. The anesthesia method of claim 1, wherein the at least one of the following: wherein the evaluation of neurological function in step 7 comprises performing restless observation record after 0-24 hours of anesthesia after gastroscopy, performing delirium observation record for 24-72 hours, performing cognitive dysfunction observation record after 1 week, and scoring with simple intelligent mental state examination scale (MMSE).

5. The anesthesia method of claim 1, wherein the at least one of the following: wherein the secondary indexes in the step 7 comprise observation records of blood pressure, pulse rate, SPO2 and respiratory rate before anesthesia, after eyelash reflex disappears, after gastroscopy and when waking up.

6. The anesthesia method of claim 1, wherein the at least one of the following: wherein the intraoperative complications in the step 7 comprise apnea, hypoxemia, nausea, vomiting, bradycardia and other conditions, postoperative constipation and urinary retention conditions.

7. The anesthesia method of claim 1, wherein the at least one of the following: wherein the effectiveness in step 7 comprises onset time: the patient failed to respond to verbal instructions and the eyelash reflex disappeared;

wake-up time: stop until such time as the handshake can be ordered and the name, birthday, and cognitive context stated;

the leaving time is as follows: the patient is conscious, has steady vital signs, can walk independently and has no obvious uncomfortable time.

8. The anesthesia method of claim 1, wherein the at least one of the following: wherein the three-party satisfaction evaluation in the step 7 comprises three-party evaluation of an anesthesiologist, an endoscopist and a subject.

Technical Field

The invention relates to an anesthesia method, in particular to an anesthesia method for protecting the nerve function of a gastroscope patient, and belongs to the technical field of anesthesia methods.

Background

With the increasing number of international outpatient short surgeries (north american outpatient surgeries have reached 70% of elective surgeries), the role of anesthesiologists in outpatient short surgeries is also highlighted. The development of short and small outpatient operations on a large scale is not practical at present due to domestic special conditions. However, after all, the development of outpatient short surgery is a trend.

At present, short and small operations in outpatients, which are participated by anesthesiologists, are mainly painless abortion operation, painless gastrointestinal endoscopy and the like in China. Although these procedures are relatively less risky, the pain is quite evident, and the intervention of the anesthesiologist brings good news to the patient and creates conditions for the examination, which soon achieves satisfactory results. However, as more and more patients are required for painless abortion, painless gastroscopy, there is a need to screen safer and more effective anesthetic drugs and anesthetic regimens with minimal impact on the neurological function of the examined patient. Only then can the patient's needs be better met.

Although the anesthesia carried out by using propofol alone in early gastroscopy is rapid and quick in recovery, the respiratory cycle inhibition of the patient is obvious, and particularly when the dosage exceeds 2mg/kg, the influence on the respiration and the cycle is very obvious, so that the anesthetic is a very unsafe factor for carrying out non-tracheal intubation general anesthesia. Aiming at the defect, the opioid compound propofol intravenous anesthesia method is widely used for painless endoscope diagnosis and treatment in clinic at present.

The results of "clinical studies of multicenter bulk samples of remifentanil complex propofol for painless gastroscopy" by watson hospital, university of sichuan "show that: the use of the remifentanil group significantly reduced the time to awakening compared to the fentanyl group. The remifentanil group also significantly improved the patient's wakefulness score compared to the fentanyl group. Therefore, on one hand, the combined application of remifentanil and propofol in gastroscopy can shorten the time for a patient to occupy a recovery room bed, improve the using turnover rate of the recovery room bed, and obviously improve the working efficiency of painless gastroscopy. On the other hand, the combined application of remifentanil and propofol to gastroscopy is also beneficial to shortening the detention time of the patient in a recovery room, so that the total diagnosis time of the patient is saved, and the diagnosis satisfaction rate of the patient is improved.

The results of the clinical observation of the safety and feasibility of sufentanil and fentanyl for painless gastroscopy made by Hubei Huangshi Hospital, China journal of digestive endoscopy, 2008, 10 th year show that: the sufentanil and propofol compound drug is used for the painless gastroscope, the combined drug has perfect effects of calming and easing pain, and can reduce the dosage of propofol compared with fentanyl, thereby relieving the side effects in the aspects of respiration, circulation and the like, shortening the awakening time, having less side reaction and quickly awakening. The influences of propofol with different doses on the cognitive function of the aged painless gastroscopy in researches such as "different doses of propofol on the cognitive function of the aged painless gastroscopy" in the 2 nd stage of shinning in 2012 of Sichuan medicine "and the influences of 65 cases of intravenous anesthesia gastroscopies on the short-term cognitive function of the aged patient in the 2 nd stage of Zhang Yong in 2012 of China and foreign health Abstract" all propose that propofol and opioid drugs may influence the cognitive function of the gastroscopy patient.

Earlier researches find that the respiratory inhibition effect of remifentanil, fentanyl and sufentanil is obvious, the apnea incidence rate is high, and certain potential safety hazards still exist; meanwhile, the cognitive function of a patient (particularly an old patient) examined by a gastroscope is influenced to a certain extent, but most of researches are small sample single-center researches, and are not verified in a population with multiple centers and large samples, so that the method has certain limitation.

To this end, an anesthesia method for protecting the neurological function of a gastroscope patient is designed to optimize the above problems.

Disclosure of Invention

The invention mainly aims to provide a anesthesia method for protecting the nerve function of a patient with a gastroscope, wherein the nerve function and safety of the patient with nalbuphine composite propofol in painless gastroscope examination anesthesia are evaluated through multi-center large sample research for the first time in China, and an ideal anesthesia scheme for the painless gastroscope is found out, so that comfortable medical treatment of the patient is guaranteed, and the risk rate is reduced. More and more patients will receive painless gastroscopies.

The purpose of the invention can be achieved by adopting the following technical scheme:

an anesthesia method for protecting the nerve function of a gastroscope patient comprises the following steps:

step 1: the 1000 patients screened according to the standard are randomly divided into five groups by a computer, and each group comprises 200 patients;

step 2: control group: NS + propofol 1 mg/kg; fentanyl group: fentanyl 0.8ug/kg + propofol 1 mg/kg; remifentanil group: remifentanil 0.5ug/kg + propofol 1 mg/kg; sufentanil group: sufentanil 0.08ug/kg + propofol 1 mg/kg; nalbuphine group: nalbuphine 0.10mg/kg + propofol 1 mg/kg;

and step 3: after the medicine dosage is calculated according to the weight of a patient subjected to gastroscopy, each group is diluted to 1ml/kg by 0.9 percent sodium chloride injection, and the medicine injection sequence is arranged;

and 4, step 4: respectively controlling the injection speeds of the first two medicines to be 60s by a specially-assigned person according to a preset medicine injection sequence and a stopwatch, and controlling the time of injecting the medicines at intervals to be 60 s;

and 5: continuously injecting the 3 rd drug at a bolus rate of 1ml/6s, and performing gastroscopy after ciliary reflex disappears;

step 6: when the patient moves in the operation, 0.5-1mg/kg of propofol is added according to the condition, the pulse rate in the operation is lower than 50 times/min, atropine is intravenously injected, the systolic pressure is lower than the basic value by 30%, ephedrine is injected statically, SPO2 is lower than 90%, and the mask assists breathing;

and 7: evaluation of neurological function, secondary index, intraoperative complication, effectiveness and three-party satisfaction evaluation are performed after observation of gastroscopy.

Preferably, the method adopts the principles of random, double-blind, control and multi-center clinical experiments and strictly executing double-blind, and specially-assigned people are responsible for accurate medicine preparation.

Preferably, the injection sequence in step 3 is the injection of opioids, propofol, and 0.9% sodium chloride, and the dispenser is not involved in the administration and data collection work.

Preferably, wherein the assessment of neurological function in step 7 comprises observing post-gastroscopy agitation observations after 0-24 hours of anesthesia, 24-72 hours of delirium events, 1 week later cognitive dysfunction observations and using a simple intelligent mental state examination scale (MMSE) score.

Preferably, the secondary indicators in step 7 include observation records of blood pressure, pulse rate, SPO2 and respiratory rate before anesthesia, after disappearance of eyelash reflex, after gastroscopy, upon waking up.

Preferably, the intraoperative complications in step 7 include apnea, hypoxemia, nausea and vomiting, bradycardia and the like, postoperative constipation and urinary retention.

Preferably, wherein the effectiveness in step 7 comprises onset time: the patient failed to respond to verbal instructions and the eyelash reflex disappeared;

wake-up time: stop until such time as the handshake can be ordered and the name, birthday, and cognitive context stated;

the leaving time is as follows: the patient is conscious, has steady vital signs, can walk independently and has no obvious uncomfortable time.

Preferably, the three-party satisfaction evaluation in the step 7 comprises three-party evaluation of an anesthesiologist, an endoscopist and a subject.

The invention has the beneficial technical effects that:

the invention provides an anesthesia method for protecting the nerve function of a gastroscope patient,

1. nalbuphine is more effective to visceral pain as a kappa receptor agonist and a mu receptor antagonist, has low respiratory depression incidence rate and capping effect, almost has no cardiovascular side effect, and is an ideal anesthetic for painless gastroscopy;

2. the clinical research that the multi-center large sample is used for painless gastroscope anesthesia on 4 opioids with equivalent dose, the nalbuphine composite propofol is obtained, the dosage of the propofol can be reduced, the circulation and the respiratory function are stabilized, the occurrence of early cognitive dysfunction is reduced, and the neural function is further protected in the painless gastroscope anesthesia. An ideal anesthesia scheme of the painless gastroscope is found out, and safe and effective comfortable medical treatment is provided for the gastroscope examination patient;

3. the nerve function and safety of a patient are evaluated in the painless gastroscopy anesthesia of the nalbuphine compound propofol for the first time through multi-center large sample research in China, an ideal anesthesia scheme of the painless gastroscopy is found out, comfortable medical treatment of the patient is guaranteed, and the risk rate is reduced. More and more patients will receive painless gastroscopies.

Detailed Description

In order to make the technical solutions of the present invention more clear and definite for those skilled in the art, the present invention is further described in detail with reference to the following examples, but the embodiments of the present invention are not limited thereto.

The anesthesia method for protecting the nerve function of a gastroscope patient provided by the embodiment comprises the following steps:

step 1: the 1000 patients screened according to the standard are randomly divided into five groups by a computer, and each group comprises 200 patients;

step 2: control group: NS + propofol 1 mg/kg; fentanyl group: fentanyl 0.8ug/kg + propofol 1 mg/kg; remifentanil group: remifentanil 0.5ug/kg + propofol 1 mg/kg; sufentanil group: sufentanil 0.08ug/kg + propofol 1 mg/kg; nalbuphine group: nalbuphine 0.10mg/kg + propofol 1 mg/kg;

and step 3: after the medicine dosage is calculated according to the weight of a patient subjected to gastroscopy, each group is diluted to 1ml/kg by 0.9 percent sodium chloride injection, and the medicine injection sequence is arranged;

and 4, step 4: respectively controlling the injection speeds of the first two medicines to be 60s by a specially-assigned person according to a preset medicine injection sequence and a stopwatch, and controlling the time of injecting the medicines at intervals to be 60 s;

and 5: continuously injecting the 3 rd drug at a bolus rate of 1ml/6s, and performing gastroscopy after ciliary reflex disappears;

step 6: when the patient moves in the operation, 0.5-1mg/kg of propofol is added according to the condition, the pulse rate in the operation is lower than 50 times/min, atropine is intravenously injected, the systolic pressure is lower than the basic value by 30%, ephedrine is injected statically, SPO2 is lower than 90%, and the mask assists breathing;

and 7: evaluation of neurological function, secondary index, intraoperative complication, effectiveness and three-party satisfaction evaluation are performed after observation of gastroscopy.

In the embodiment, the method adopts the principles of random, double-blind, contrast and multi-center clinical experiments and strictly executes double-blind, and a specially-assigned person is responsible for accurate dispensing.

In this embodiment, the injection sequence in step 3 is set up as opioid, isopropyl phenol, and 0.9% sodium chloride injection, and the dispenser does not participate in the administration and data collection.

In this example, wherein the assessment of neurological function in step 7 comprises performing a follow-up restless observation recording 0-24 hours after anesthesia after gastroscopy, a follow-up recording of delirium events 24-72 hours, a follow-up recording of cognitive dysfunction after 1 week and using a simple intelligent mental state examination scale (MMSE) score.

In this embodiment, the secondary indicators in step 7 include observed records of blood pressure, pulse rate, SPO2 and respiratory rate before anesthesia, after eyelash reflex extinction, after gastroscopy, upon awakening.

In this example, the intraoperative complications in step 7 include apnea, hypoxemia, nausea, vomiting, bradycardia, postoperative constipation, and urinary retention.

In this embodiment, the effectiveness in step 7 includes the onset time: the patient failed to respond to verbal instructions and the eyelash reflex disappeared;

wake-up time: stop until such time as the handshake can be ordered and the name, birthday, and cognitive context stated;

the leaving time is as follows: the patient is conscious, has steady vital signs, can walk independently and has no obvious uncomfortable time.

In the present embodiment, the three-party satisfaction evaluation in step 7 includes three-party evaluation of the anesthesiologist, the endoscopist and the subject.

The above description is only for the purpose of illustrating the present invention and is not intended to limit the scope of the present invention, and any person skilled in the art can substitute or change the technical solution of the present invention and its conception within the scope of the present invention.