目的 观察环泊酚在老年患者无痛胃肠镜检查中的麻醉效果和不良反应。方法 选择80例65岁以上行无痛胃肠镜检查的老年患者,将患者随机分为环泊酚组（C组）40例和丙泊酚组（P组）40例。每例患者均静脉注射舒芬太尼0.08 μg/kg,30 s后C组给予环泊酚0.3 mg/kg、P组给予丙泊酚1.5 mg/kg。记录2组患者麻醉前（T₀）、睫毛反射消失时（T₁）、置入胃镜后即刻（T₂）和操作结束时（T₃）的心率（HR）和平均动脉压（MAP）;记录2组患者检查操作时间、清醒时间、追加药物次数及静脉注射痛、呼吸抑制、呛咳、体动等不良反应发生情况。结果 2组患者行胃肠镜检查操作时间、麻醉清醒时间和追加药物次数比较差异无统计学意义（P>0.05）。与T₀时间点（102.6±14.1 mmHg）比较,P组患者的MAP在T₁（86.0±12.5 mmHg）、T₂（86.1±13.2 mmHg）、T₃（92.8±12.6 mmHg）时间点明显下降,差异有统计学意义（P<0.05）;与C组T₁（95.9±10.8 mmHg）、T₂（96.3±9.6 mmHg）时间点比较,P组的MAP在T₁（86.0±12.5 mmHg）、T₂（86.1±13.2 mmHg）时均明显降低（P<0.05）。C组患者静脉注射痛、呼吸抑制的发生率明显低于P组（P<0.05）;2组体动和呛咳的发生率比较差异无统计学意义（P>0.05）。结论 环泊酚0.3 mg/kg在老年患者胃肠镜检查中能提供和丙泊酚1.5 mg/kg相似的麻醉效果,环泊酚组的老年患者发生注射痛、血压下降、呼吸抑制的比例更低。

Objective To observe the effect of ciprofol and propofol in painless gastroenteroscopy in elderly patients．Methods A total of 80 elderly patients aged 65 or above who underwent painless gastroenteroscopy were randomly divided into a group of 40 patients receiving ciprofol（Group C）and a group of 40 patients receiving propofol（Group P）．All patients were given sufentanil 0.08 μg/kg,and group C was given ciprofol 0.3 mg/kg,group P was given propofol 1.5 mg/kg after 30 seconds．The heart rate（HR）and mean arterial pressure（MAP）of two groups of patients before anesthesia（T₀）,at the disappearance of eyelash reflex（T₁）,after gastroscopy insertion（T₂）,and at the end of the procedure（T₃）were recorded．The operating time,anesthesia awakening time,number of additional medications and the adverse reactions such as injection pain,respiratory depression,cough,body movements were also recorded．Results There were no significant differences（P>0.05）in the gastroenteroscopy operating time,recovery time and number of additional medications between the two groups．Compared with T₀ time point（102.6±14.1 mmHg）,the MAP of group P patients significantly decreased at T₁（86.0±12.5 mmHg）,T₂（86.1±13.2 mmHg）and T₃（92.8±12.6 mmHg）time points（P<0.05）．Compared with Group C at T₁（95.9±10.8 mmHg）,T₂（96.3±9.6 mmHg）time points,the MAP of Group P decreased significantly at T₁（86.0±12.5 mmHg）and T₂（86.1±13.2 mmHg）time points（P<0.05）．The incidences of injection pain and respiratory depression in group C were significantly lower than those in group P（P<0.05）．There was no statistically significant difference in the incidences of body movements and cough between the two groups（P>0.05）．Conclusions Ciprofol 0.3 mg/kg combined with sufentanil can provide anesthesia effect similar to that of propofol 1.5 mg/kg combined with sufentanil in gastroenteroscopy of elderly patients．The proportions of injection pain,blood pressure decreasing and respiratory depression in elderly patients in the ciprofol group were lower．

目的 对比纳布啡联合环泊酚、纳布啡联合丙泊酚应用于老年患者无痛胃镜中的效果。方法 选取厦门市中医院2021年10月至2022年10月收治的180例老年患者（均行无痛胃肠镜检查）为研究对象,按照随机数表法分组,其中A组90例患者给予纳布啡联合环泊酚,B组90例患者给予纳布啡联合丙泊酚,对比两组患者麻醉相关指标、血流动力学、围术期不良反应。结果 两组患者诱导量、诱导时间、追加次数、总追加量、苏醒时间、恢复室停留时间对比差异均无统计学意义（t=1.486、0.830、1.157、0.941、0.906、1.403,均P>0.05）;重复测量方差分析结果显示,分组因素间收缩压（SBP）（F=30.019,P<0.001）、心率（HR）（F=282.057,P<0.001）、SpO₂（F=64.518,P<0.001）、;时间因素SBP（F=21.780,P<0.001）、HR（F=345.118,P<0.001）、SpO₂（F=41.762,P<0.001）;分组与时间交互时间因素SBP（F=12.941,P<0.001）、HR（F=193.295,P<0.001）、SpO₂（F=13.546,P<0.001）,差异均有统计学意义。折线图直观显示,A组患者SBP、HR、SpO₂、较B组低。;A组患者围术期不良反应发生率（20.00%）低于B组患者（56.67%）（χ²=25.593,P<0.001）。结论 两种麻醉方案应用于老年无痛胃肠镜,麻醉效果相近,环泊酚复合纳布啡血流动力学更稳定,且围术期不良反应的发生率较低。

Objective To compare the effects of nalbuphine combined with ciprofol and nalbuphine combined with propofol on painless gastroscopy in elderly patients. Methods A total of 180 elderly patients（all underwent painless gastroscopy）admitted to Xiamen Traditional Chinese Medicine Hospital from October 2021 to October 2022 were selected as the study subjects．They were randomly divided into groups using a random number table method．Among them,90 patients in Group A were given a combination of nalbuphine and ciprofol,while 90 patients in Group B were given a combination of nalbuphine and propofol．Anesthesia related indicators,hemodynamics,and perioperative adverse reactions were compared between the two groups．There was no statistically significant difference in the induction amount,induction time,number of additional times,total additional amount,awakening time,and recovery room stay time between the two groups of patients（t=1.486,0.830,1.157,0.941,0.906,1.403,all P>0.05）．The results of repeated measures analysis of variance showed that there were statistically significant differences among the grouping factors,including SBP（F=30.019,P<0.001）,HR（F=282.057,P<0.001）,SpO₂（F=64.518,P<0.001）,time factors SBP（F=21.780,P<0.001）,HR（F=345．118,P<0.001）,SpO₂（F=41.762,P<0.001）,and interaction factors SBP（F=12.941,P<0.001）,HR（F=193.295,P<0.001）,and SpO₂（F=13.546,P<0.001）．The line chart visually shows that the SBP,HR,SpO₂ of Group A patients were lower than those of Group B．The incidence of perioperative adverse reactions in Group A patients（20.00%）was lower than that in Group B patients（56.67%）（χ²=25.593,P<0.001）. Conclusions The two anesthesia regimens used for elderly painless gastroscopy have similar anesthesia effects,with more stable hemodynamics of ciprofol combined with nalbuphine,and a lower incidence of perioperative adverse reactions．

目的 探讨无痛消化内镜下高频电刀治疗对胃癌前病变的应用效果及复发率的影响。方法 选取甘肃医学院附属医院2017年1月—2020年1月收治的120例胃癌前病变患者进行回顾性分析,依照其手术治疗方案将其分为两组,各60例。对照组采取常规内镜黏膜下剥离术,观察组患者采取无痛消化内镜下高频电刀剥离治疗。对比两组的切除速度、切除面积、治愈性切除率、完全及整块切除率,对患者进行3年随访,记录其复发情况,并对比两组患者并发症情况。结果 两组的切除面积、治愈性切除率、完全切除率及整块切除率对比差异无统计学意义（P>0.05）,观察组切除速度为（27.34±8.58）mm²/min,高于对照组的（15.54±4.52）mm²/min,差异有统计学意义（P<0.05）。两组患者术后3年的总复发率（28.33% vs 30.00%）对比差异无统计学意义（P>0.05）。观察组感染、穿孔等相关并发症发生率为3.33%,低于对照组的15.00%（P<0.05）。结论 无痛消化内镜下高频电刀与常规内镜黏膜下剥离术治疗胃癌前病变相比具有显著疗效。但无痛消化内镜下高频电刀治疗可提升切除速度,降低并发症发生率。

Objective To explore the application effect and recurrence rate of painless endoscopic high-frequency electrocautery on gastric precancerous lesions．Methods A total of 120 patients with precancerous gastric cancer admitted to the Affiliated Hospital of Gansu Medical College from January 2017 to January 2020 were selected for retrospective analysis and divided into two groups according to their surgical treatment plan,with 60 patients in each group．The control group underwent conventional endoscopic submucosal dissection,and the patients in the observation group received painless digestive endoscopic high-frequency electric knife dissection．The resection speed,resection area,curative resection rate,complete and bulk resection rate were compared of the two groups,the patients were followed up for 3 years to record the recurrence rate,and the complications of the two groups of patients were also compared．Results There were no differences in resection area,curative resection rate,complete resection rate and total resection rate between the two groups（P>0.05）．The resection speed in the observation group was（27.34±8.58）mm²/min,which was higher than that in the control group（15.54±4.52）mm²/min（P<0.05）．There was no difference in the total recurrence rate（28.33% vs 30.00%）at 3 years after surgery between the two groups（P>0.05）．The incidence of infection,perforation and other related complications in the observation group was 3.33%,lower than that in the control group（15.00%）（P<0.05）．Conclusion sCompared with conventional endoscopic submucosal dissection,high-frequency electric knife under painless digestive endoscopy has significant efficacy in the treatment of gastric precancerous lesions．However,painless endoscopic high-frequency electrosurgical treatment can improve the resection speed and reduce the incidence of complications such as infection,perforation and bleeding．

目的 探讨无痛镇静在胃镜下上消化道异物取出术中的应用价值。方法 回顾分析2017年5月1日—2020年5月1日在东莞东华医院消化内镜中心接受内镜下上消化道异物取出术患者,对其临床资料进行分析,总结比较在无痛镇静下和普通胃镜下上消化道异物取出术两组患者的诊疗效果。结果 共357例患者,行胃镜下异物取出术共372次,其中无痛镇静组99例,普通组273例,其中15例患者在普通胃镜下异物取出术失败改为无痛镇静下胃镜取出术成功取出,最终10人异物未取出转外科或上级医院;在无痛镇静下行胃镜上消化道异物取出术比普通胃镜下异物取出术成功率高(P＜0.05),黏膜损伤、出血、穿孔等并发症少(P＜0.05),人均费用低(P＜0.05);无痛镇静后患者血氧饱和度、血压下降(P＜0.05),心率升高(P＜0.05),其中老年人影响明显(P＜0.05),但不影响患者内镜操作,氟马西尼催醒后心率、血氧饱和度、血压恢复正常(P＞0.05)。结论 在无痛镇静下行胃镜上消化道异物取术安全、有效、成功率高、医疗费用少,患者易于接受的好方法,值得推广。

Objective To explore the application value of painless gastroscope in the removal of foreign body in upper gastrointestinal tract. Methods The study involved patients who visited at the department of endoscopy center at Hospital (Dongguan, China). Retrospective analysis of patients undergoing endoscopic removal of foreign bodies in the upper gastrointestinal tract from May 1, 2017 to May 1, 2020. We analyzed the patients' clinical data and compared the diagnosis and treatment effect between the painless gastroscope group and normal gastroscopy group. Results A total of 357 patients were included, 372 times of removal of foreign body under gastroscope were conducted. A total of 99 cases in painless gastroscope group were treated by painless gastroscope with painless sedation, 273 cases in normal gastroscopy group were treated by normal gastroscopy, among them, 15 cases were failed to removal the foreign body treated by normal gastroscopy, and turned into the painless sedation gastroscopy. Finally, 10 patients with foreign bodies were not removed and transferred to surgical department or higher level hospitals. In the treatment of endoscopic foreign body removal, the success rate of painless gastroscope group was higher (P<0.05), the complication incidence of mucosal injury, bleeding and perforation and cost per capita were lower than that of normal gastroscopy(P<0.05). Following painless sedation, the blood oxygen saturation, blood pressure dropped (P<0.05) and heart rate increased (P<0.05), the effect of the sedatives on the elderly was the most obvious (P<0.05), but it did not affect the patient's endoscopic operation, and the heart rate, blood oxygen saturation and blood pressure (P>0.05) after awakening. Conclusion Painless gastroscope in the removal of foreign body in upper gastrointestinal tract is safe, effective high success rate, less medical cost, and easy for patients to accept, it should be widely applied.

目的 探察老年冠心病无痛性心肌缺血的临床护理效果。方法 选取我院冠心病患者68例,按照护理方式的不同分为观察组与对照组,每组34例;对照组患者给予常规护理,观察组在对照组的基础上给予患者优质的临床护理;观察两组患者的临床护理效果。结果 临床护理后,两组患者的症状均有缓解,但观察组患者心肌缺血的发作次数、发作时间、ST段压低减少的次数及下移减少量显著优于对照组,结果差异有统计学意义(P＜0.05)。结论 对老年冠心病无痛性心肌缺血患者采用针对性合适的临床护理,缓解了患者的临床症状,减少了心肌缺血的发作次数,改善了患者的并发症,效果显著,值得推广。

目的 探讨综合中医护理措施在无痛人工流产术后调复中的效果。方法 将100例无痛人流病人随机分为观察组和对照组各50例,对照组手术前后予常规护理。观察组在对照组的基础上,采取综合中医护理措施。结果 观察组术后阴道出血量、出血时间、腹痛持续时间等少于对照组,月经按时复潮率高于对照组(P<0.05)。结论 综合中医护理干预对无痛人工流产病人具有良好的调复作用,可以有效地提高患者术后舒适度,促进患者早日康复,值得临床推广应用。

目的 观察对应手术时点小剂量丙泊酚抑制无痛人工流产手术孕者应激反应的有效性。方法 选择门诊自愿在全麻下行无痛人工流产手术的早孕妇女80例,ASAⅠ或Ⅱ级,随机分为前臂头静脉组(A组)、下肢踝前大隐静脉组(B组)。两组早孕者分别在抬臀铺入无菌臀巾时(T₁)、置入窥器即刻(T₂)、钳夹宫颈即刻(T₃)时点,推注不同剂量丙泊酚,观察记录麻醉效果相关指标。结果 A组追加丙泊酚次数与B组相比少(P<0.01),A组丙泊酚用量与B组相比减少(P<0.01),A组术毕到唤醒睁眼的时间与B组相比缩短,差异有统计学意义(P<0.01)。结论 对应手术操作时点经上肢头静脉小剂量推注丙泊酚能较好的抑制无痛人工流产手术孕者应激反应,且苏醒快,并发症少。