舒芬太尼复合咪唑安定清醒镇静用于老年患者胃镜检查时最佳配伍剂量的研究

The Optimal Dose of Sufentanil Combined with Midazolam with Conscious Sedation in Aged Patients for Gastroscopy

目的：探讨舒芬太尼复合咪唑安定清醒镇静用于行胃镜检查的老年患者时的最佳配伍剂量。方法：按权重配方法的配伍原则,将舒芬太尼和咪唑安定分为六个配伍组：Ⅰ组（S0.05M20）,Ⅱ组（S0.10M30）,Ⅲ组（S0.10M10）,Ⅳ组（S0.15M20）,Ⅴ组（S0.20M10）,Ⅵ组（S0.20M20）,单位均为μg/kg。180例ASAⅠ-Ⅲ级拟行无痛胃镜检查的老年患者,随机分到此6组中,每组30例。观察患者的镇静效果,血流动力学和呼吸的变化,术中、术后的不良反应。结果：只对Ⅱ组-Ⅵ组中未追加依托咪酯的患者进行统计分析。Ⅲ组的镇静深度明显弱于其他组（P〈0.05）,遗忘程度最低（P〈0.05）,Ⅵ组的呼吸频率和SpO2明显低于其他组（P〈0.05）,Ⅱ组在离院评分达8分时,MAP明显低于Ⅳ组和Ⅴ组（P〈0.05）,Ⅴ组的完全无遗忘率高达22.7%。结论：0.15μg/kg舒芬太尼复合20μg/kg咪唑安定清醒镇静用于行无痛胃镜检查的老年患者时,对患者的生理功能影响小,遗忘程度高,术中及术后的不良反应少,患者的满意度高,是较为理想的配伍组。

Objective： To find out the optimal dose of sufentanil combined with midazolam for conscious sedation in aged patients undergoing gastroscopy. Methods： According to the principle of weighted modification method, 180 ASA Ⅰ - Ⅲ outpatients undergoing gastroscopy were randomly assigned into the following groups ： group Ⅰ （ S0.05 M20 ）, group Ⅱ （ S0. 10 M30 ）, group （S0.10M10）, gronp Ⅳ （S0.15M20）, gronpⅤ （S0.20M10）, and Ⅵ （S0.20M20）- OAA/S scores, hemodynamic arid respiratory changes, the adverse reactions during and postexamnation were recorded. Results： There were significant differences in sedative scores and anmesia between group Ⅲ and the other groups （ P 〈 0.05 ） . The ratio of apnea and dyspnea and the decreasing degree of SpO2 of group Ⅵ was significantly higher than that of the orther groups （ P 〈 0.05）. At the time of consciousness the MAP of group Ⅱ was the lowest （ P 〈 0.05）. Conclusion： It was found that 0.15 μg/kg sufentanil combined with 20 μg/kg midazolam was the optimal dose with conscious sedation in aged patients for gastroscopy.