摘要
目的探讨咪唑安定复合芬太尼在结肠镜检查中的镇静镇痛作用及护理支持。方法165例ASAⅠ～Ⅱ级患者随机分为2组：无痛结肠镜检查组（A，n=95），传统结肠镜检查组（B，n=70）。A组静脉推注咪唑安定0．05mg／kg、芬太尼1μg／kg，1～2min开始进行结肠镜检查；B组施行传统结肠镜检查。观察镇静、镇痛、满意、遗忘的程度、愿意再次检查调查及心率、血压、血氧饱和度的变化。结果A组注药开始检查后1minMAP、SpO2较注药前有明显下降（P〈0．01），5、10和15min时时段无显著性差异（P〉0．05），呼吸抑制（SpO2〈90％），发生率占3．2％；B组检查开始后1、5、10和15min时MAP及HR较检查前明显上升（P〈0．01）。A组93％患者达Ramsay2～3级清醒镇静镇痛。A组镇静、镇痛、满意及遗忘程度和愿意再次检查率均明显优于B组（P〈0．01）。结论咪唑安定联合芬太尼用于结肠镜检查中，可显著改善患者的耐受性，具有良好的镇静镇痛效果，是安全有效的；且护理支持中必须加强呼吸、循环监护及镇静观察。
Objective To investigate the sedative and analgesic effect and nursing support of the application of midazolam combined with fentanyl on painless colonoscopy. Methods One hundred and sixty five cases of ASA Ⅰ--Ⅱ were randomly divided into 2 groups： group A （painless colonoscopy, n = 95）, group B （conventional colonoscopy, n = 70）. Group A was checked with midazolam 0.05 mg/kg.fentanyl 1μg/kg iv plus before operation; Group B was checked with conventional colonoscopy. Results There was statistical difference in the variation of MAP,SpO2 at 1min in operation, which was lower than before injection in Group A （P 〈 0.01）. There was no significant difference at 5,10 and 15min in group A （P ：〉 0.05）. The incidence of respiratory inhibition（SpO2 〈 90%）was 3.2% （3/95）. There was statistical difference in the MAP,HR of 1,5,10 and 15rain during operation, which was higher than before operation in group B（P〈0.01）. There was 93%（88/95） at Ramsay2-3 grade of sedation and analgesia in group A. The grade of sedation, analgesia, satisfaction of endoscope inspection, forgetful level and the incidence of again examination in group A were better than in group B （P 〈 0.01）. Conclusions Midazolam combine fentanyl on colonoscopy shows high satisfaction with sedation and anesthesia. It is safe and can ameliorate the tolerance of patients to endoscopy. Nursing supports should be strengthened such as respiratory and electrocardiac monitoring, observation of the depth of sedation.
基金
盐田区2005年度第一批科技计划项目（深盐科[2005]2号、2005W01）
