不同剂量咪唑安定在肥胖患者无痛胃肠镜麻醉中的作用

Midazolam for painless gastrointestinal endoscopy in obese patients

目的:观察不同剂量咪唑安定用于肥胖患者无痛胃肠镜检查中的安全性以及最佳剂量.方法:126例肥胖患者随机分为A、B、C、D4组.A、B、C 3组于镜检前分别静脉推注咪唑安定剂量0.01、0.02、0.03 mg/kg,D组为对照组,不使用咪唑安定.同时4组患者静脉滴注芬太尼1μg/kg,3 min后缓慢静脉推注异丙酚1.0-2.0 mg/kg,至患者睫毛反射消失,进入睡眠状态后给予镜检.术中如有体动反应,追加异丙酚0.3-0.5 mg/kg,每次30-50 mg.观察各组血压、心率、SpO2、异丙酚用量以及不良反应的发生.记录患者和镜检医生的满意度.结果:A、B、C组异丙酚首次剂量分别为95.62 mg±16.59 mg、87.50 mg±13.81 mg以及79.09 mg±16.74 mg明显少于D组(126.67mg±20.48 mg,具有统计学差异(P<0.05),异丙酚总量B、C组(128.83 mg±22.65 mg)和(125.30 mg±26.95 mg)明显少于D组(157.23mg±33.39 mg)(P<0.05),A组(146.64 mg±28.03 mg)与D组无统计学差异(P>0.05).A、B、C组术中低氧血症和面罩辅助呼吸发生率(3.03%、3.33%、12.12%)较D组(26.67%)减少,但C组头晕嗜睡情况发生率(51.51%)明显高于其他各组(15.15%、20.00%、13.33%)(P<0.05).结论:咪唑安定-芬太尼-异丙酚复合麻醉用于肥胖患者无痛胃肠镜检查是安全的,咪唑安定0.02 mg/kg既能减少异丙酚的用药首剂量和总剂量,同时并发症少苏醒快,可作为推荐剂量.

AIM： To assess the efficacy and safety of differ- ent doses of midazolam for gastrointestinal en- doscopy in obese patients. METHODS： One hundred and twenty-six pa- tients who underwent painless gastroscopy were randomly divided into four groups： A, B, C and D. Groups A, B, and C were intravenously given 0.01, 0.02, and 0.03 rng/kg of midazolam before the examination, respectively, while group D was not given midazolam. All patients were in- travenously given fentanyl 1 μg/kg and propo- fol 1.0-2.0 mg/kg 3 rain later. If the patient had somatic reaction, an additional propofol 0.3-0.5 mg/kg was given. The blood pressure （BP）, heart rate （HR）, SpO2 the initial and total doses of propofol, side effects, as well as the patient＇s and doctor＇s satisfaction were recorded. RESULTS： The initial dose of propofol in groups A, B and C （95.62 mg ± 16.59 rag, 87.50 mg ± 13.81 mg, 79.09 mg ± 16.74 mg） were sig-nificantly less than that in group D （126.67 mg ± 20.48 mg） （P 〈 0.05 for all）, while the total dose of propofol were less in groups B and C than in group D （P 〈 0.05 for both）, but had no statistical difference between groups A and D. The rates of hyoxemia and assisted ventilation in groups A, B and C （3.03%, 3.33%, 12.12%） were lower than that in group D （26.67%） （P 〈 0.05 for all）, but the incidence of dizziness and sleepiness in group C （51.51%） was significantly higher than those in ther groups （P 〈 0.05 for all）. CONCLUSION： In obese patients, application of midazolam in painless gastrointestinal endos- copy is simple, safe and effective.