咪达唑仑增强丙泊酚与芬太尼在镜下肠息肉摘除术的麻醉效果

Observation of Midazolam enhance the Effect of propofol combined with fentanyl in the Resection of Colorectalpolyps by Colonoscopy

目的观察小剂量咪达唑仑是否增强丙泊酚与芬太尼在肠镜下肠息肉摘除术的麻醉效果。方法无痛肠镜下肠息肉摘除术患者120例,按麻醉方式不同分为两组,每组60例。实施丙泊酚联合芬太尼为对照组,在对照组用药前加用小剂量咪达唑仑0.06 mg/kg为观察组,比较肠镜下息肉摘除术中两组两组手术时间、苏醒时间、使用丙泊酚总量和追加使用丙泊酚次数;两组患者麻醉后HR和BP变化值比较以及使用麻黄素、呼吸抑制及术后恶心、呕吐发生率;两组患者和内镜医生分别对麻醉满意度。结果两组的手术时间和苏醒时间比较差异无统计学意义(P>0.05),观察组使用丙泊酚总量和追加使用丙泊酚次数均少于对照组,差异有统计学意义(P<0.05);两组患者麻醉诱导后血压变化值比较差异无统计学意义(P>0.05),对照组麻醉开始后的一分钟内心率增快明显高于观察组,差异有统计学意义(P<0.05),两组使用麻黄素例数差异无统计学意义(P>0.05),对照组出现呼吸抑制12例,观察组出现3例,差异有统计学意义(P<0.05)。观察组患者苏醒后术后恶心、呕吐发生率明显低于对照组,差异有统计学意义(P<0.05);观察组的消化科医师和患者对麻醉的满意度明显高于对照组,差异有统计学意义(P<0.05)。结论肠镜下息肉摘除术中使用小剂量咪达唑仑可增强丙泊酚与芬太尼的麻醉效果,减少丙泊酚用量、呼吸抑制、术后恶心、呕吐发生率,提高内镜医生和患者的满意度。

Objective To observe whether the application of low-dose midazolam enhances the anesthesia effect of propofol combined with fentanyl in endoscopic resection of colorectalpolyps.Methods 120 patients underwent the painless endoscopic resection of colorectalpolyps in our hospital were divided into two groups according to diffferent anesthesia methods(n=60).Propofol combined with fentanyl were implemted in patients of control group.The observation group consisted of patients receiving low-dose midazolam(0.06 mg/kg)before the application of propofol combined with fentanyl.The operation time,recovery time,the total amount of propofol usage and the number of additional propofol use were compared between the two groups during the endoscopic resection;the changes of heart rate(HR)and blood pressure(BP)after anesthesia and the use of ephedrine,respiratory depression and postoperative nausea and vomiting incidence;the anesthesia satisfaction of gastroenterologists and patients in two groups during the endoscopic resection were compared.Results There were no significant differences in operation time and recovery time between the two groups(P>0.05).Compared with control group,the total amount of propofol usage and the number of additional propofpl use were lower in observation group(P<0.05).There was no significant difference in BP changes of patients between the two groups(P>0.05),while HR of patients in observation group did not increase significantly within one minute after anesthesia compared with control group(P<0.05).There was no significant difference in the number of cases of ephedrine use between the two groups(P>0.05).There were 12 cases of respiratory depression in the control group and 3 cases in the observation group,and the difference was statistically significant(P<0.05).The incidence of postoperative nausea and vomiting in the observation group after waking up was significantly lower than that in the control group(P<0.05).Gastroenterologists and patients in the observation group were significantly more satisfied with anesthesia than those in the control group(P<0.05).Conclusion The application of low-dose midazolam could enhance the anesthesia effect of fentanyland combined with propofol in endoscopic resection of colorectalpolyps,decrease the usage of propofol and respiratory depression,reduce the incidence of postoperative nausea and vomiting and improve the satisfaction of gastroenterologists and patients.