不同剂量芬太尼联合咪哒唑仑在纤维支气管镜检查中的镇静效果和安全性研究

The sedative effects and safety of different doses of fentanyl in combination with midazolam on application of fiberoptic bronchoscopy

目的探讨纤维支气管镜检查中采用不同剂量芬太尼联合咪达唑仑镇静麻醉的有效性及安全性。方法将60例择期行纤维支气管镜检查的患者随机分为两组,每组30例。在利多卡因局麻的基础上,A组给予芬太尼0.2μg/kg联合咪达唑仑0.05 mg/kg静脉注射镇静,B组给予芬太尼0.5μg/kg联合咪达唑仑0.1 mg/kg静脉注射镇静。比较两组用药前及用药后1、3、5、10 min不同时间点心率(HR)、舒张压(SBP)、收缩压(DBP)及血氧饱和度(Sp O2)变化情况,以及苏醒时间、不良反应等。结果两组用药后各时间点HR、SBP、DBP比较差异无统计学意义(P>0.05);用药后3 min两组Sp O2均较麻醉前降低,但B组较A组下降更为明显(P<0.05)。A组苏醒时间、不良反应发生率、操作知晓情况均低于B组(P<0.05)。结论芬太尼0.2μg/kg联合咪哒唑仑0.05 mg/kg用于纤维支气管镜的检查中具有良好的镇静效果,对Sp O2影响小,患者无不良记忆,不良反应少,安全性高,苏醒快,具有较高临床应用价值。

Objective To explore the sedative effects and safety of different doses of fentanyl in combination with midazolam on the applieanion of fiberoptic bronchoscopy. Methods Sixty patients undergoing fiberoptic bron- choscopy were randomly divided into two groups, with 30 cases in each group. On the basis of the local anesthesis of lidocaine was given, group A was given fentanyl 0.2 μg/kg combined with midazolam 0.05 mg/kg intravenously for sedation, and group B was given fentanyl 0. 5μg/kg combined with midazolam 0. 1 mg/kg intravenously for sedation. The changes of heart rate（ HR）, diastolic blood pressure（ SBP）, systolic blood pressure（ DBP）, blood oxygen satu- ration（ SpO2 ） and recovery time and adverse reactions were compared between the two groups before the treatment and 1, 3, 5 and 10 minutes after the administration. Results After the treatment at each time point, there were no sig- nificant differences in HR, SBP and DBP between the two groups （ P 〉 0.05 ）. SpO2 decreased in both of the two groups 3 min after the anesthesia, but it decreased more significantly in group B than in group A（P 〈0. 05 ）. The recovery time, incidence of adverse reactions and the awareness rate of anesthesia in group A were significantly lower than those in group B （ P 〈 0. 05 ）. Conclusion Fentanyl 0. 2 μg/kg in combination with midazolam 0. 05 mg/kg has a good sedative effect and a little effect on oxygen saturation in the patients receiving inspection of fiber bronchoscope.