海南医科大学学报

目的：观察不同剂量的阿芬太尼联合丙泊酚用于无痛胃镜检查的有效剂量及安全性。方法：选择2021年1月～2021年12月行无痛胃镜检查的患者240例，随机数字表法分为对照组、阿芬太尼不同剂量组（N1组、N2组、N3组、N4组和N5组，注射剂量分别为5、6、7、8和10μg/kg），各40例。对照组采用丙泊酚注射麻醉，阿芬太尼不同剂量组采用不同剂量的阿芬太尼复合丙泊酚麻醉。检查完毕评估麻醉效果。比较各组心率（HR）、收缩压（SBP）、呼吸暂停时间、胃镜置入不耐受反应发生率及不良反应。结果：与给药前比较，胃镜置入前各组的SBP和HR均降低（P<0.01）；胃镜置入后1 min时对照组SBP和HR均升高（P<0.01）,N3、N4组SBP降低（P<0.01）,HR无变化（P>0.05）,N5组SBP和HR均降低（P<0.01）。与胃镜置入前比较，在胃镜置入后1 min时，对照组、N1、N2和N3组的SBP和HR均升高（P<0.01）,N4和N5组SBP和HR均无明显变化（P>0.05）。阿芬太尼不同剂量组呼吸暂停时间均低于对照组（P<0.01）,N5组呼吸暂停时间高于N1组、N2组、N3组、N4组（P<0.01）。6组胃镜置入不耐受反应发生率以及呛咳反应、干呕反射、吞咽反射及肢体反应率差异无统计学意义（P>0.05）;6组无痛胃镜检查后瘙痒、恶心呕吐、焦虑烦躁、头晕嗜睡及腹泻便秘发生率差异无统计意义（P>0.05）。结论：8μg/kg阿芬太尼联合丙泊酚用于无痛胃镜检查时麻醉效果确切，呼吸循环稳定，不良反应发生率低。

Objective: To observe the effective dose and safety of different doses of alfentanil combined with propofol in painless gastroscopy. Methods: A total of 240 patients who underwent painless gastric examination from January 2021 to December 2021 were randomly divided into a control group and a different dose group of alfentanil(N1 group, N2 group, N3 group, N4group, and N5 group, with injection doses of 5, 6, 7, 8, and 10 μg/kg, respectively) using a number table method, with 40 patients in each group. The control group was anesthetized with propofol injection, while different dosage groups of alfentanil were anesthetized with different doses of alfentanil combined with propofol. Evaluating the anesthesia effect after the examination is completed. The heart rate(HR), systolic blood pressure(SBP), apnea time, incidence of intolerance to gastroscopy insertion, and adverse reactions in each group were compared. Results: Compared with before administration, SBP and HR in all groups decreased before gastroscopy placement(P<0.01); At 1 minute after gastroscopy insertion, both SBP and HR in the control group increased(P<0.01), while SBP in the N3 and N4 groups decreased(P<0.01), while HR remained unchanged(P>0.05). Both SBP and HR in the N5 group decreased(P<0.01). Compared with before gastroscopy insertion, SBP and HR in the control group, N1, N2, and N3 groups increased 1 minute after gastroscopy insertion(P<0.01), while there was no significant change in SBP and HR in the N4 and N5 groups(P>0.05).The apnea time of different dosage groups of alfentanil was lower than that of the control group(P<0.01), and the apnea time of N5 group was higher than that of N1 group, N2 group, N3 group, and N4group(P<0.01).There was no significant difference in the incidence of intolerant reactions during gastroscopy insertion, cough reaction, retching reflex, swallowing reflex and limb movement reaction rate between the six groups(P>0.05); there was no statistically significant difference in the incidence of itching, nausea, vomiting, anxiety, dizziness, drowsiness, diarrhea, and constipation after painless gastroscopy examination among the six groups(P>0.05). Conclusion: The combination of 8 μg/kg alfentanil and propofol has a definite anesthesia effect, stable respiratory and circulatory system, and low incidence of adverse reactions when used for painless gastroscopy.