舒芬太尼咪达唑仑联合布托啡诺清醒镇静用于鼾症患者胃镜检查的临床研究

Clinical study of sufentanil midazolam combined with butorphanol conscious sedation for gastroscopy in patients with snoring

目的:探讨舒芬太尼咪达唑仑联合布托啡诺清醒镇静用于鼾症患者行内镜检查的可行性和安全性。方法:选择武警四川省总队医院2021年7月—2022年10月行无痛胃镜检查的中重度鼾症患者100例,采用随机数字表法等分为S组(50例)、B组(50例),两组均于咽喉部表麻后静脉注射咪达唑仑1mg+舒芬太尼5μg,S组追加舒芬太尼0.08~0.15μg/kg,B组追加布托啡诺8~10μg/kg。观察患者入检查室时(T_(0))、内镜检查前(T_(1))、内镜经过咽喉部(T_(2))、内镜进入十二指肠(T_(3))、退内镜时(T_(4))、离开恢复室(T_(5))时的心率(HR)、血压、血氧饱和度(SpO_(2))。术中采用行为疼痛量表(BPS)评估患者内镜检查过程中的疼痛程度,以Ramsay镇静量表(RSS)评估患者麻醉深度,观察患者术中恶心发生情况;术后麻醉恢复期观察头晕、嗜睡、困乏、恶心呕吐、遗忘等并发症发生情况,用视觉模拟评分量表(VisualAnalogueScale,VAS)评价患者的疼痛情况,并记录患者离院时间。结果:S组有3例患者,B组2例患者内镜检查过程中放弃清醒镇静退出实验,其余95例患者(S组47例,B组48例)在清醒镇静下完成内镜检查。各观察时点两组间收缩压(SBP)、舒张压(DBP)、HR、SpO_(2)差异均无统计学意义(P>0.05)。术中,B组BPS评分和恶心发生率低于S组,差异有统计学意义(P<0.05);两组RSS评分比较,差异无统计学意义(P>0.05)。S组术后恢复期低氧血症(SPO_(2)<90%)、嗜睡、头晕发生率高于B组,困乏发生率低于B组,差异有统计学意义(P<0.05)。两组患者术后VAS评分、离院时间比较,差异无统计学意义(P>0.05)。结论:咪达唑仑、舒芬太尼联合布托啡诺清醒镇静方案用于中重度鼾症患者胃镜检查,能有效减轻患者的痛苦,且维持术中循环稳定,呼吸抑制轻,术后并发症少。

Objective To explore the feasibility and safety of sufentanil midazolam combined with butorphanol conscious sedation for endoscopy in patients with snoring.Methods One hundred patients with moderate-to-severe snoring who underwent painless gastroscopy in the Armed Police Forces Hospital of Sichuan from July 2021 to October 2022 were selected and divided into group S(50 cases)and group B(50 cases)using the random number table method.Both groups were given intravenous injection of midazolam 1 mg+sufentanil 5μg after topical anesthesia in the throat,and group S was given additional sufentanil.The heart rate(HR),blood pressure,and blood oxygen saturation(SpO)of the patients were observed when the patients entered the examination room(T_(0)),before endoscopy(T_(1)),when the endoscope passed through the pharynx(T_(2)),when the endoscope entered the duodenum(T_(3)),when the endoscope was retreated from the endoscope(T_(4)),and when the patients left the recovery room(T_(5)).The intraoperative behavioural pain Scale(BPS)was used to assess the degree of pain during endoscopy,the Ramsay Sedation Scale(RSS)was used to assess the depth of anaesthesia in patients,and to observe the occurrence of nausea in patients during the operation;During the recovery period of anaesthesia in the postoperative period,the occurrence of complications,such as dizziness,drowsiness,drowsiness,nausea and vomiting,and amnesiawere observed.In addition,the visual analogue scale(VAS)was used to evaluate the pain of the patients,and the time of patients'discharge was recorded.Results Three patients in group S and two patients in group B gave up conscious sedation and withdrew from the experiment during endoscopy,and the remaining 95 patients(47 patients in group S and 48 patients in group B)completed endoscopy under conscious sedation.The differences in systolic blood pressure(SBP),diastolic blood pressure(DBP),HR,and SpO_(2)between the two groups at each observation point were not statistically significant(P>0.05).During the operation,the incidence of BPS score and nausea in group B was lower than that in group S,and the difference was statistically significant(P<0.05);The difference in RSS score between the two groups was not statistically significant(P>0.05).The incidence of postoperative recovery hypoxaemia(SPO_(2)<90%),somnolence,and dizziness was higher than that in group S,while the incidence of drowsiness was lower than that in group B,and the difference was statistically significant(P<0.05).Comparison of postoperative VAS scores and discharge time between the two groups of patients showed no statistically significant difference(P>0.05).Conclusions Midazolam and sufentanil combined with butorphanol conscious sedation protocol for gastroscopy in patients with moderate-to-severe snoring effectively reduces patient's pain and maintains intraoperative circulatory stability,mild respiratory depression,and few postoperative complications.