小剂量咪唑安定和芬太尼在患者经皮冠状动脉介入术中镇静疗效

Sedative effect of midazolam combining fentanyl in low dose in patients during percutaneous coronary intervention

目的观察小剂量咪唑安定联合芬太尼在患者经皮冠状动脉介入术(PCI)中的镇静效果。方法 390例拟行PCI的冠心病患者随机为对照组和观察组,观察组静脉注射咪唑安定0.04mg/kg+芬太尼1μg/kg;对照组静脉注射等量生理盐水。记录患者术前、穿刺时、支架置入时、手术结束即刻、术后2h的心率、平均动脉压(MAP)、呼吸频率、血氧饱和度(SpO2),分别在术后进行镇痛、镇静评分及在术前、术后进行焦虑评分。结果两组患者呼吸频率差异无统计学意义(P>0.05),两组患者术中SpO2均>96%;观察组MAP、心率在整个PCI手术过程波动幅度较对照组平稳。两组患者在PCI术后的镇静评分有显著的统计学差异(P<0.01),但两组镇痛效果差异不显著(P>0.05)。两组患者PCI术前焦虑评分无统计学差异(P>0.05),而术后2h两组患者的焦虑评分及观察组术前、术后2h焦虑评分的差异均有显著统计学意义(P<0.01)。结论小剂量咪唑安定联合芬太尼在PCI术患者中取得较好的镇静、抗焦虑效果,且呼吸及血流动力学稳定。

Objective To observe the sedative effect of midazolam combining fentanyl in low dose in patients during percutaneous coronary intervention.Methods The patients with coronary heart disease（CHD,n=390） planed to have percutaneous coronary intervention（PCI） were randomly divided into control group and observation group.The observation group was given midazolam（0.04 mg/kg） combining fentanyl（1 μg/kg） by venous injection and control group was given equivalent normal saline solution.The heart rate,mean arterial pressure（MAP）,breathing rate（BR） and oxygen saturation（SpO2） were recorded before PCI,during PCI,at time of implanting stent,and at the moment of PCI end and 2 hours after PCI.The patients were given analgesic and sedative scoring after PCI,and anxiety scoring before and after PCI.Results The difference in BR had no statistical significance between two groups（P〉0.05）.The value of SpO2 was over 96% in two groups during PCI.In observation group,MAP and heart rate were more stable during PCI than those in control group.The scores of sedation had significant and statistical difference between two groups after PCI（P〈0.01）,but difference in analgesic effect had no significance（P〉0.05）.The anxiety scores had no statistical difference between two groups before PCI（P〉0.05）,and the difference in anxiety scores between two groups 2 hours after PCI,and the difference in observation group before PCI and 2 hours after PCI had statistical significance（P〈0.01）.Conclusion Midazolam combining fentanyl in low dose has better sedative and anti-anxiety effects in patients with PCI,and can keep stable respiratory and hemodynamics.