瑞芬太尼复合咪达唑仑在监测麻醉管理下结肠镜检查的临床观察

Clinical observation of remifentanil combined with midazolam for MAC used for painless colonoscopy

目的探讨瑞芬太尼复合咪达唑仑监测麻醉管理(MAC)用于结肠镜检查的可行性与安全性。方法将180例自愿行结肠镜检查患者随机分为瑞芬太尼复合咪达唑仑组(RM组),舒芬太尼复合咪达唑仑组(SM组)和常规组(C组),每组60例。RM组、SM组均缓慢注入咪达唑仑0.04mg/kg;2min后,RM组给予瑞芬太尼1μg/kg,后以0.05μg/(kg·min)持续静脉泵注;SM组给予舒芬太尼0.2μg/kg。C组实施常规结肠镜检查。记录基础值(T0)、检查开始(T1)、手术结束(T2)3个时间点的血压、HR、SpO_2、Ramsay评分,数字等级评定量表(NRS),并发症包括呼吸抑制、肢体扭动、恶心呕吐、头晕及头晕持续时间等。结果 3组患者均顺利完成手术。与C组比较,RM组、SM组结肠镜检查时间缩短(P<0.05);RM组术中Ramsay分级2~4级,术中疼痛NRS评分低(P<0.01),术中血流动力学平稳;RM组头晕发生率及持续时间明显低于SM组,术后恢复快,留院时间短。结论瑞芬太尼复合咪达唑仑MAC用于结肠镜检查安全,患者清醒、镇痛、镇静,血流动力学平稳,副作用小。

Objective To explore the feasibility and security of remifentanil combined with midazolam for monitoring anesthesia care（MAC）used for colonoscopy.Methods A totol of 180 voluntary patients receiving colonoscopy were separated into three groups：group RM（remifentanil combined with midazolamg）,group SM（sufentanil combined with midazolam）and group C（contrast group）.And each group contained 60 patients.0.04 mg/kg midazolam were injected into both patitents of group RM and group SM.2 minutes later,1μg/kg remifentanil was injected into patients of group RM,and then conduct continuous intravenous pump injection at the rate of 0.05μg/（kg·min）;0.2 mg/kg sufentanil was injected into patients of group SM;group C only took regular colonoscopy.The blood pressure,HR,SpO2,Ramsay sedation scale,recovery time（when patients wake up when call them）,complications,including nausea,vomiting,body twisting,respiratory depression,dizziness and lasting time,etc at three time：base value（T0）,before examination（T1）,after operation（T2）were recorded.ResultsOperations were all smoothly conducted in three groups;compared with group C,the colonoscopy examination time of group RM and group SM were shorter（P〈0.05）;the ramsay sedation scale of group RM was level 2-4,the NRS rank was at low level（P〈0.01）,and the Haemodynamics conditions was stable;the dizziness rate and lasting time of group RM were significantly lower than group SM.The recovery time was fast and the time remain in hospital under observation was short.Conclusion Remifentanil combined with midazolam for MAC can be used safely in painless colonoscopy.Patients are awake,analgesia,sedative,with stable hemodynamics and little side effects.