不同剂量芬太尼伍用异丙酚、咪唑安定用于胃镜检查中的比较

Comparative study of different doses of fentanyl with propfol and midazolam used in gastroscopy

目的比较不同剂量的芬太尼复合异丙酚、咪唑安定在胃镜检查中的镇静程度及对呼吸循环的影响。方法选择门诊无痛胃镜患者400例(ASAⅠ、Ⅱ级)随机分为4组:A组即对照组(异丙酚1.20mg/kg+咪唑安定0.04mg/kg),B组(异丙酚1.20mg/kg+咪唑安定0.02mg/kg+芬太尼0.50μg/kg),C组(异丙酚1.20mg/kg+咪唑安定0.02mg/kg+芬太尼1.00μg/kg),D组(异丙酚1.20mg/kg+咪唑安定0.02mg/kg+芬太尼1.50μg/kg)各100例。观察术中HR、MAP、SpO2及镇静程度、呼吸抑制、清醒时间等。结果4组基础HR、MAP、SpO2值差异无显著性(P>0.05)。B、C和D组与A组比较经咽MAP值差异有显著性(P<0.05,P<0.01),各组间查胃MAP值差异无显著性(P>0.05)。B、C和D组经咽HR值及查胃HR值与A组比较差异有显著性(P<0.01)。A、B和C3组经咽SpO2值及查胃SpO2值差异无显著性(P>0.05)。D组经咽SpO2值及查胃SpO2值与A组相比差异有显著性(P<0.01)。B、C和D3组呛咳病人显著少于A组(P<0.01),C、D组躁动病人显著少于A组(P<0.05,P<0.01),D组呼吸抑制病人显著多于A组(P<0.05)。结论异丙酚1.20mg/kg+咪唑安定0.02mg/kg复合芬太尼0.50￣1.00μg/kg用于胃镜检查安全且效果最佳,为无痛胃镜术的最佳方案。

[Objective] To compare the effect on sedation,respiration and circulation of different doses of Fentanyl with Propofol and Midazolam used in gastroscopy. [Methods] 400 patients（ASA grade Ⅰ , Ⅱ ） undergoning gastroscopy were randomly divided into four groups： GroupA（Propofol 1.2 mg/kg＋ Midazolam 0.04 mg/kg）; Group B （Propofol 1.2 mg/kg＋ Midazolam 0.02 mg/kg ＋ Fentanyl 0.5 ug/kg）; Group C （Propofol 1.2 mg/kg＋ Midazolam 0.02 mg/kg ＋ Fentanyl 1.0 mg/kg）; Group D （Propofol 1.2 mg/kg＋ Midazolam 0.02 mg/kg ＋ Fentanyl 1.5 ug/kg）. HR, MAP, SpO2, grade of sedation, respiratory inhibition, time for recovery of consciousness were recorded. [Results] The MAP of B, C, D passing through the larynx were significantly lower than A （P〈0.05, P〈0.01）, the HR of B, C, D passing through the larynx and checking the stomach were significantly lower than A （P 〈0.01）, the SpO2 of D was significantly lower than A （P 〈0.01）, the restlessness in C, D were better than in A （P 〈0.05, P 〈0.01）, the coughing patients in B, C, D were less than in A （P 〈0.01）, the respiratory inhibiting patients in D were more than in A （P 〈 0.05）. [Conclusion] Propofol 1.2 mg/kg, Midazolam 0.02 mg/kg,and Fentanyl 0.5-1.0 ug/kg were safe and most effective in Gastroscopy.