阿芬太尼或舒芬太尼复合咪达唑仑与丙泊酚在无痛胃肠镜检查的效果

Efficacy of afentanil or sufentanil in combination with midazolam and propofol in painless gastrointestinal endoscopy

目的探讨阿芬太尼或舒芬太尼复合咪达唑仑和丙泊酚在无痛胃肠镜检查的效果。方法选择行无痛胃肠镜检查患者150例,男62例,女88例,年龄30~60岁,体重45~90 kg,ASAⅠ或Ⅱ级。按照随机数字表法分为两组:阿芬太尼+咪达唑仑组(AM组)、舒芬太尼+咪达唑仑组(SM组),每组75例。AM组静脉注射咪达唑仑0.02 mg/kg、阿芬太尼6μg/kg,SM组静脉注射咪达唑仑0.02 mg/kg、舒芬太尼0.06μg/kg。静脉注射丙泊酚1~2 mg/kg至改良警觉/镇静(MOAA/S)评分为0分时停止注射丙泊酚,立即开始胃肠镜操作。记录丙泊酚首次剂量、总消耗量、追加次数。记录起效时间、操作时间、意识恢复时间和PACU停留时间。记录胃镜插入咽喉部(T_(1))、结肠镜插入肛门(T_(2))、过脾曲(T_(3))、过肝曲(T_(4))时改良非插管患者行为疼痛量表(BPS-NI)评分。记录患者和内镜医师满意率,低血压、低氧血症、心动过缓、心动过速、呛咳等不良反应发生情况。结果与SM组比较,AM组丙泊酚首次剂量明显减少(P<0.05),起效时间、PACU停留时间明显缩短(P<0.05),T_(1)时BPS-NI评分明显降低(P<0.05),患者和内镜医师满意率明显升高(P<0.05),呛咳发生率明显降低(P<0.05)。结论在无痛胃肠镜检查中应用阿芬太尼复合咪达唑仑和丙泊酚,减少丙泊酚用量,缩短起效时间和PACU停留时间,降低呛咳发生率,有利于提高无痛胃肠镜检查的效率和有效性。

Objective To investigate the effect of alfentanil or sufentanil combined with midazolam and propofol in painless gastrointestinal endoscopy.Methods A total of 150 patients,62 males and 88 females,aged 30-60 years,weighing 45-90 kg,ASA physical statusⅠorⅡ,underwent painless gastrointestinal endoscopy.They were divided into two groups according to random number table method:alfentanil+midazolam group(group AM)and sufentanil+midazolam group(group SM),75 patients in each group.Group AM was given with midazolam 0.02 mg/kg,alfentanil 6μg/kg intravenously,while group SM was given with midazolam 0.02 mg/kg,sufentanil 0.06μg/kg intravenously.The two groups were intravenously given propofol of 1-2 mg/kg.When the modified observer’s assessment of alertness/sedation score(MOAA/S)was zero,propofol injection was stopped and gastrointestinal endoscopy was started immediately.The initial dosage of propofol,total dosage of propofol,additional times of propofol,onset time,operation time,consciousness recovery time and PACU stay time were recorded.The modified behavioral pain scale scores for non-intubated patients(BPS-NI)when gastrointestinal endoscopy passed over the throat(T_(1)),anus(T_(2)),spleen curvature(T_(3))and liver curvature(T_(4))were recorded.The patient satisfaction and endoscopist satisfaction and the occurrence of adverse reactions such as hypotension,hypoxemia,bradycardia,tachycardia and cough were recorded.Results Compared with group SM,the initial dosage of propofol in group AM was significantly reduced(P<0.05),the onset time and PACU stay time in group AM were significantly shortened(P<0.05),the BPS-NI score in group AM was significantly reduced at T_(1)(P<0.05),the satisfaction rate of patients and endoscopists in group AM was significantly increased(P<0.05),and the incidence of cough in group AM was significantly reduced(P<0.05).Conclusion The application of alfentanil combined with midazolam and propofol in painless gastrointestinal endoscopy can reduce dosage of propofol,shorten the onset time and PACU stay time,reduce the incidence rate of cough and help to improve the efficiency and effectiveness of the painless gastrointestinal endoscopy.