针刺镇痛结合咪达唑仑、瑞芬太尼在肠镜检查中的应用

Acupucture combined with midazolam and remifentanil used in colonoscopy

目的研究针刺镇痛配伍使用咪达唑仑、瑞芬太尼在肠镜检查的镇痛、镇静效果。方法80例门诊肠镜检查患者随机分为2组,即针刺复合药物组(针刺镇痛配伍使用咪达唑仑、瑞芬太尼,Ⅰ组)和单纯药物组(咪达唑仑复合瑞芬太尼,Ⅱ组)。针刺取穴均为双侧合谷、右侧足三里、上巨虚,左侧阴陵泉、三阴交。连续监测患者血压、心率、氧饱和度(Sp0_2)变化;分别记录两组患者用药情况、插镜至回盲部时间、术中与术后不良反应以及检查后患者满意度。结果80例患者全部完成了肠镜检查,Ⅰ组患者瑞芬太尼用量及其最大效应室浓度均低于Ⅱ组(P<0.01);Ⅱ组患者术中MAP较给药前显著下降(P<0.05),同时术中HR亦低于Ⅰ组(P<0.05),两组患者SpO_2并无统计学差异。两组患者检查后满意度无明显不同。结论针刺镇痛配伍使用咪达唑仑、瑞芬太尼能有效地用于结肠镜检查的镇静镇痛,同时和单纯药物组相比可显著减少瑞芬太尼的用药量,术中及术后不良反应更少见,研究显示针刺能显著增强瑞芬太尼的镇痛作用。

Objective To evaluate the sedative and analgesic efficacy of acupuncture analgesia and combination with midazolam and remifentanil during colonoscopy. Methods Eighty outpatients scheduled for colonoscopy were randomly divided into two groups： acupucture-drug compound group（combination of acupuncture analgesia and midazolam and remifentanil, Group Ⅰ ）and drug group （combination of midazolain and remifentanil,Group Ⅱ ）. The acupuncture point of bilateral Hegu and right Zusanli,Shangjuxu and left Yinlingquan ,Sanyinjiao were selected for acupuncture analgesia. The BP ,HR ,SpO2 in both groups were continuously monitored during the study. Time to reach cecum,adverse reaction and patient＇s satisfaction were recorded. Results Colonoscopy was well tolerated in all patients. The dose and maximum effect com- partment concentration of remifentanil administered during colonoscopy were significantly lower in group Ⅰ. After bolus injection of remifentanil, MAP was decreased in group Ⅱ （ P 〈0.05 ） and HR was lower in group Ⅰ during operation than that in group Ⅱ （P 〈0.05 ）. There was no statistical difference in SpO2 between two groups. Patient satisfaction was no difference between two groups also. Conclusion Combination of acupuncture analgesia and midazolam and remifentanil can provide adequate sedation and analgesia during colonoscopy. The dose of remifentanil administered is significantly decreased with combination of drugs and acupuncture. Side effects especially nausea and vomiting are fewer. The result showed that acupuncture can significantly enhance analgesic efficacy of remifentanil.