咪达唑仑联合地佐辛用于消化内镜检查镇静镇痛的有效性和安全性分析

Efficacy and Safety Analysis of Midazolam Combined with Dezocine for Sedation and Analgesia in Gastrointestinal Endoscopy

目的:探究咪达唑仑联合地佐辛用于消化内镜检查镇静镇痛的有效性及安全性。方法:选取2020年10月—2022年10月在广德市中医院进行消化内镜检查的患者82例,应用随机数字表法将其分为对照组(n=41)及观察组(n=41),对照组接受咪达唑仑联合瑞芬太尼麻醉,观察组接受咪达唑仑联合地佐辛麻醉。对比两组患者麻醉效果[苏醒时间、定力恢复时间]、患者满意度,用药前(T_(0))、用药结束(T_(1))、检查开始(T_(2))、检查结束(T_(3))、定力恢复(T_(4))时的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2)),术后10、20、30 min视觉模拟评分法(visual analogue scale,VAS)评分,术前和苏醒后5、30 min蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分及不良反应发生率。结果:观察组苏醒时间、定力恢复时间均短于对照组(P<0.05);对照组满意度评分低于观察组(P<0.05)。T_(1)~T_(3)时两组HR、MAP、SpO_(2)均较T_(0)下降(P<0.05),T_(0)、T_(1)、T_(4)时两组HR、MAP比较,差异均无统计学意义(P>0.05);T_(2)、T_(3)时对照组MAP、HR均低于观察组(P<0.05);T_(0)~T_(4)时两组SpO_(2)水平比较,差异均无统计学意义(P>0.05)。两组术后10、20、30 min VAS评分比较,差异均无统计学意义(P>0.05)。两组术前MoCA评分比较,差异无统计学意义(P>0.05);术后5 min两组MoCA评分均较术前降低、术后30 min对照组MoCA评分低于术前,差异均有统计学意义(P<0.05),观察组术后30 min MoCA评分较术前差异无统计学意义(P>0.05)。观察组不良反应发生率(4.88%)低于对照组(26.83%),差异有统计学意义(P<0.05)。结论:咪达唑仑联合地佐辛用于消化内镜检查中,镇静镇痛效果确切,患者恢复认知时间较短,提高患者满意度,且安全性较高,值得在消化内镜检查麻醉中应用推广。

Objective:To investigate the effectiveness and safety of Midazolam combined with Dezocine for sedation and analgesia in gastrointestinal endoscopy.Method:A totoal of 82 patients who underwent gastrointestinal endoscopy in Guangde Hospital of Traditional Chinese Medicine from October 2020 to October 2022 were selected and divided into the control group(n=41)and the observation group(n=41)by random number table method.The control group received Midazolam combined with Remifentanil anaesthesia,and the observation group received Midazolam combined with Dezocine anaesthesia.The anaesthesia effects[awakening time,fixation recovery time],patient satisfaction,heart rate(HR),mean arterial pressure(MAP),and blood oxygen saturation(SpO_(2))at the time of pre-medication(T_(0)),the end of medication(T_(1)),the beginning of the examination(T_(2)),the end of the examination(T_(3)),and the recovery of fixation(T_(4)),the visual analog scale(VAS)scores at 10,20,30 min after surgery,Montreal cognitive assessment(MoCA)scores before surgery and 5 and 30 min after awakening and the incidence of adverse reactions were compared between the two groups.Result:The recovery time and fixation recovery time of the observation group were shorter than those of the control group(P<0.05).The satisfaction score of control group was lower than that of observation group(P<0.05).HR,MAP and SpO_(2) of the two groups were decreased from T_(1) to T_(3) compared with T_(0)(P<0.05),and there were no statistical significance in HR and MAP between the two groups at T_(0),T_(1) and T_(4)(P>0.05).At T_(2) and T_(3),MAP and HR of control group were lower than those of observation group(P<0.05).There were no significant differences in SpO_(2) levels between the two groups at T_(0)-T_(4)(P>0.05).There were no significant differences in VAS scores at 10,20 and 30 min after surgery between the two groups(P>0.05).There was no significant difference in MoCA score before surgery between the two groups(P>0.05).MoCA scores 5 min after surgery in both groups were lower than those before surgery;MoCA score 30 min after surgery in control group was lower than before surgery,with statistical significance(P<0.05);MoCA score 30 min after surgery in observation group had no statistical significance compared with before surgery(P>0.05).The incidence of adverse reactions in observation group(4.88%)was lower than that in control group(26.83%),the difference was statistically significant(P<0.05).Conclusion:Midazolam combined with Dezocine used in gastrointestinal endoscopy,the sedative and analgesic effect is accurate,the time of patients'cognitive recovery is shorter,the patient's satisfaction is improved,and the safety is higher,it is worth to be applied and popularised in the anaesthesia of gastrointestinal endoscopy.