咪唑安定联合芬太尼在肥胖患者胃镜检查中的应用

Application of midazolam combined with fentanyl in gastroscopy examination for patients of obesity

目的观察低剂量咪唑安定联合芬太尼在肥胖患者胃镜检查中的临床效果,并评估其安全性。方法选择本院2012年6月~2013年12月收治的需行胃镜检查的肥胖患者200例作为研究对象,按照数字随机法分组,每组100例,对照组采取咽部喷雾利多卡因局麻,观察组于局麻基础上采取低剂量咪唑安定联合芬太尼,观察比较2组临床效果。结果 2组麻醉前生命体征相关指标心率（HR）、平均动脉压（MAP）及4个不同时间SPO2均无明显差异（P〉0.05）,麻醉后（T2）、进镜1min（T3）、手术结束时（T4）观察组HR、MPP均较对照组更加平稳（P〈0.05）;观察组患者术后对胃镜检查感受舒适67例、尚可27例、不适5例、难受1例,明显优于对照组（P〈0.05）;观察组出现恶心、呕吐5例（5.0%）,咳嗽7例（7.0%）,躁动3例（3.0%）,呃逆4例（4.0%）,不良反应发生率19例（19.0%）,明显低于对照组46例（46.0%）,P〈0.05。结论低剂量咪唑安定联合芬太尼在肥胖患者胃镜检查中的临床效果较佳,不良反应少,较为安全。

Objective To observe the clinical effect of low dose of midazolam combined with fentanyl in gastroscopy examination for patients of obesity ,and to evaluate its safety .Methods We selected 200 cases of patients of obesity who need gastroscopy treat‐ment in our hospital from June 2012 to December 2013 as the research objects .The patients were divided into two groups accord‐ing to random number table with 100 cases in each group .The control group accepted the pharyngeal spraying lidocaine local anes‐thesia ,while the observation group adopted low dose midazolam combined with fentanyl on the basis of local anesthesia .Results The two groups′heart rate （HR） ,mean arterial pressure （MAP） and four different time of SPO2 showed no significantly different be‐fore anesthesia （P〉0 .05） .The HR ,MPP after anesthesia （T2 ） ,1 min （T3 ） after the mirror entering and the end of operation （T4 ） for observation group were more stable （P〈 0 .05）;In the observation group ,patients felt comfortable 67 cases ,fair 27 ca‐ses ,discomfort 5 cases ,pain 1 case ,which was significantly better than the control group （P〈0 .05）;In the observation group nausea ,vomiting 5 cases （5 .0% ） ,cough 7 cases （7 .0% ） ,agitation 3 cases （3 .0% ） ,hiccup 4 cases （4 .0% ） ,the total incidence of adverse reactions was 19 cases （19 .0% ） , significantly lower than the control group of 46 cases （46 .0% ） （ P〈 0 .05 ） . Conclusion Low dose midazolam combined with fentanyl in obese patients has a better clinical effect and less adverse reaction com‐pared with the control group .