摘要
目的比较不同剂量的咪达唑仑和丙泊酚滴定给药对患者呼吸、循环及术后恢复的影响,探讨咪达唑仑复合丙泊酚滴定法在老年无痛胃肠镜检查中的安全性。方法选择2017年9月至2018年3月拟于门诊行无痛胃镜联合肠镜检查的患者87例进行前瞻性研究,按随机数字表法分为三组:P组(n=29)、M1组(n=29)、M2组(n=29)。P组患者依次给予丙泊酚1 mg/kg+丙泊酚0. 5 mg/kg; M1组患者依次给予咪达唑仑0. 03 mg/kg+丙泊酚0. 6 mg/kg; M2组患者依次给予咪达唑仑0. 03 mg/kg+咪达唑仑0. 03 mg/kg+丙泊酚0. 3 mg/kg。分次静脉滴定给药,至Richmond躁动镇静评分(RASS)为-5分即停止给药开始内镜检查,内镜检查过程中根据患者的RASS评分和临床体征追加丙泊酚0. 5 mg/kg。观察患者呼吸抑制发生率及持续时间、脉搏血氧饱和度、低血压发生率、丙泊酚消耗量、苏醒时间、术后定向力评分、患者满意度等指标。结果 M2组呼吸抑制发生率(58. 6%)、呼吸抑制持续时间中位数(25. 0 s)明显低于P组(85. 7%,80. 0 s)和M1组(86. 2%,60. 0 s),差异有显著性(P <0. 05),P组和M1组比较差异无统计学意义(P> 0.05)。单因素方差分析显示,三组患者达到离院标准的时间、定向力评分、术者操作满意度、患者满意度、患者舒适度差异无统计学意义(P> 0. 05)。M2组患者苏醒时间(12. 0 min)长于P组(8. 0 min),差异有显著性(P <0. 05)。三组患者丙泊酚总消耗量比较,P组> M1组> M2组,差异均具有统计学意义(P <0. 05)。结论咪达唑仑复合丙泊酚滴定法给药应用于老年无痛胃肠镜检查中有利于提高老年患者麻醉的安全性。复合0. 06 mg/kg咪达唑仑可显著减少呼吸抑制发生,减轻血流动力学波动,且不延长术后离院时间。
Objective To compare the effects of combining propofol and midazolam on respiratory,circulation as well as postoperative recovery of patients undergoing GI endoscopy.Methods 87 patients undergoing painless GI endoscopy from September 2017 to March 2018 were enrolled prospectively.Patients were randomized into three groups.Group P:1 mg/kg propofol+0.5 mg/kg propofol(n=29).Group M1:0.03 mg/kg midazolam+0.6 mg/kg propofol(n=29).Group M2:0.03 mg/kg midazolam+0.03 mg/kg midazolam+0.3 mg/kg propofol(n=29).All patients received 0.08μg/kg sufentanil intravenously before sedative induction.Titration was not suspended until RASS score reached-5.Endoscopy was performed.An extra 0.5 mg/kg propofol was given if necessary.Multiple indexes evaluating safety of anesthesia were observed.Results The incidence of respiratory depression(58.6%)and median duration of respiratory depression(25.0 s)in group M2 were significantly lower than in group P and group M1(P<0.05),but there was no significant difference between group P and group M1(P>0.05).Differences in departure time,postoperative orientation score,patient satisfaction,patient comfort and operator satisfaction were not significant among three groups(P>0.05).The recovery time in group M2(12.0 min)was longer than in group P(8.0 min)(P<0.05).The amount of propofol consumption was different among the three groups(P<0.05).Conclusion Combining propofol and midazolam titration in elderly GI endoscopy is conducive to anesthesia safety.Midazolam of 0.06 mg/kg can significantly reduce respiratory depression and hemodynamic fluctuation without lag of patient discharge.
作者
高颖
张雨洁
刘缚鲲
张晔
田鸣
GAO Ying;ZHANG Yu-jie;LIU Fu-kun(Department of Anesthesiology,Beijing Friendship Hospital,Caital Medical University,Beijing 100050,China)
出处
《临床和实验医学杂志》
2018年第23期2572-2575,共4页
Journal of Clinical and Experimental Medicine
关键词
老年人
无痛胃肠镜检查
咪达唑仑
丙泊酚
呼吸抑制
Elderly
Gastrointestinal endoscopy
Midazolam
Propofol
Respiratory depression
作者简介
通讯作者:田鸣,E-mail:13601167650@139.com。
