瑞芬太尼复合丙泊酚或咪唑安定在无痛纤维胆道镜下胆管扩张术中的应用

The application of remifentanil-propofol and remifentanil -midazolam analgesia forcholedochofiberscopic dilatation of bile duct

目的评估瑞芬太尼复合丙泊酚或咪唑安定用于纤维胆道镜下胆管球囊扩张术的镇痛镇静的安全性和有效性。方法回顾接受无痛纤维胆道镜下胆管球囊扩张术的患者95例，其中行瑞芬太尼复合丙泊酚（PR组）输注43例，行瑞芬太尼复合咪唑安定（MR组）输注52例。记录两组患者给药前及给药后心率（HR）、血压（MAP）、呼吸频率（RR）和血氧饱和度（SPO2）的变化，记录给药后的镇静程度和镇痛效果，记录术后患者的记忆情况，以及患者围术期不良反应的发生情况。结果与基础值比较，PR组给药后10min及20min时HR增加，20min时MAP升高；MR组给药后20min时HR增加（P〈0．05）。与PR组比较，MR组MAP在给药20min时降低（P〈0．05）。两组镇痛效果相似（P〉0．05），改良OAA／S评分在3—4分者MR组（67％）多于PR组（28％，P〈0．01），MR组对操作记忆少，无局部注射痛，患者满意度高（P〈0．05）。结论瑞芬太尼复合丙泊酚或咪唑安定均可以安全的用于纤维胆道镜下胆管球囊扩张术。瑞芬太尼复合咪唑安定血流动力学稳定，顺行性遗忘作用强，镇静时间适中，不良反应少。

Objective To evaluate the safety and efficacy of remifentanil-propofol and remifentanil- midazolam analgesia for choledochofiberscopie dilatation of bile duct. Methods 95 patients undergoing choledochofiberseopic dilatation of bile duct were reviewed, 43 of which were dealt with remifentanil-propofol （PR） and 52 with remifentanil-midazolam （MR）. After medication, changes of HR, MAP, RR and SPO2 were observed. The effects of sedation and analgesia, the instance of amnesia, and side effects were recorded. Results HR in group PR and MR were increase at 10 to 20 min and 20 rain respectively after medication. MAP in group PR was increased at 20 rain, which were decreased in group MR （ P 〈 0. 05 ）. Compared with group PR, group MR achieved similar analgesia （ P 〉 0.05 ） , more moderate sedation with modified OAA/S score of 3 -4 （67% vs 28%, P 〈 0. 01 ）, less memory, less injection pain, and higher satisfaction （P 〈 0. 05 ）. Conclusion Both remifentanil-propofol and remifentanil-midazolam can provide safe and effective sedation and analgesia for choledochofiberscopic dilatation of bile duct. Remifentanil- midazolam provides more stable hemodynamics, more amnesia, moderate sedation duration and less side effects.