胃镜检查中咪唑安定的应用及其安全性的探讨

The investigation in application and security of midazolam for upper gastrointestinal endoscopy

目的:探讨咪唑安定在胃镜检查中的可行性及安全性.方法:487例胃镜检查者,随机分为药物组及对照组,药物组静脉推注0.04～0.1mg/kg.在检查前、中、后分别观察其呼吸、心率、血压及指氧饱和度的变化情况,记录检查过程中的健忘程度、总体感受等指标.结果:静脉用药后,完全遗忘者59.66%;部分遗忘者26.10%;无遗忘者11.25%.无不适者78.97%;有不适者19.312%;难以忍受者1.71%.用药组中其呼吸、心率、血压及指氧饱和度在检查前、中、后均存在有变化,其差异有统计学意义(P＜0.001),用药后在检查中呼吸频率加快,与对照组比较有差异,P＜0.05.药物组血压及心率的变化,与对照组比较无显著性差异,P＞0.05.药物组与对照组在胃镜检查中、后,其低指氧饱和度的发生率分别为1.71%、0.49%及1.32%、2.63%.两组之间的差异无统计学意义(P＞0.05).各剂量组之间其参数的变化没有差异(P＞0.05).结论:咪唑安定对呼吸频率有影响,对心率、血压及氧饱和度没有影响;≤0.1mg/kg的咪唑安定静脉应用于胃镜检查是安全可行的.

Objective：To investigate the feasibility and sccurity of midazolam for upper gastrointestinal endoscopy. Methods ：487 patients requiring upper gastrointestinal endoscopy were allocated randomly to control group and drug group. The drug group was intravenously given midazolam 0.04～0. 1mg/kg.The frcquency of respiration,heart ratc,blood pressure and oxygen saturation were measured in pre- examination,recta-examination and post-examination stage. The degree of amnesia, patient acceptance during the procedure were noted by a physician after the examination. Results：The incidence of total amnesia, meri- amnesia, unamncsia was 59.66%, 26.10% and 11.25 % respectively, and no complaints, complaints, unbearable complaints were 78.97%, 19.31% and 1.71% in respectively drug group. The parameters of R,P, Bp and SPO2 in pre-examination, recta - examination and post-examination stage were changed in the drug group. The changes were statistically significant （ I~〈 0. 001 ）. The frequency of respiration accelerated during the procedure in the drug group,which was significantly different from that in the control group. （P〈 0.05 ）. There were no significant differences in heart rate and blood prcssure between the drug and control group, P 〉0.05. The incidence rates of low SPO2 in drug group and control group were 1.71% and 1.32 % respectively during the examination, while 0.49 % and 2.63 % after the examination. The difference was not significant between the two groups（ P 〉0.05 ）. There was no significant change in the parameteers of each dosage groups（ P 〉 0.05）.Conclusion ：The frcequency of respiration is affected by midazolam, but heart rate, blood pressure and oxygen saturation are not. The dosage smaller than 0. 1mg/kg of midazolam can produce safe and effective sedation for gastroscopy.