小剂量咪唑安定-氯胺酮-异丙酚在纤维胃镜检查中的应用

The applicance of small dosage imidazole diazepam-Ketamine-diso profol in fiber gastroscopy

目的 研究小剂量咪唑安定 -氯胺酮 -异丙酚 (MKP)组合在纤维胃镜检查中的镇静/镇痛作用及其对呼吸循环的影响。方法 60例门诊纤维胃镜检查患者 (ASAI～Ⅱ级 ) ,随机分为C、M及MKP3组 (n=20) ,C组仅作咽喉部表麻 ,M组和MKP组则分别在C组基础上静注咪唑安定0.07mg/kg或咪唑安定0.015～0.02mg/kg、氯胺酮10～15mg、异丙酚0.5mg/kg。观察各组镇静/镇痛效应、检查中症状及记忆缺失、循环和指脉搏氧饱和度 (SpO2)的变化。结果 C组对胃镜检查留下痛苦记忆 ,M组和MKP组对胃镜检查的耐受程度相似 ,但MKP组镇静/镇痛、检查合作及记忆缺失程度、清醒及离院时间明显优于M组 (P<0.05) ;MKP组用药1min后平均动脉压 (MAP)较C组、M组略低 ,但无统计学意义 ,心率 (HR)、SpO23组均在正常范围。结论 小剂量咪唑安定、氯胺酮、异丙酚组合不仅显著增加镇静/镇痛和遗忘效应 ,而且较单用咪唑安定的清醒时间更短 ,可安全用于门诊胃镜检查。

Objective To study the sedation and analgesic effect and influence on respiration and circulation of small dosage imidazole di-azepam-Ketamine-disoprofol(IKD)in fiber gastroscopy. Methods 60patients received gastroscopy(ASA I-II)were randomly divided into3groups:C,Mand IKD(n=20).Patients of group C was only given surface anesthesia and patients of group Mand IKD were not only given surface anesthesia,but given imidazole diazepam0.07mg/kg and imidazole diazepam0.015～0.02mg/kg-Ketamine10～15mg-disoprofol0.5mg/kg respectively.The change of sedation or analgesic effect,symptom and memory deficit,circulation and SpO2were observed. Results Patients of group C all left distress memory to gastroscopy.The tolerance degree in patients of group Mand IKD were similar to gastroscopy,but in patients of group IKD,the degree of sedation or analgesic effect,check co-operation,memory deficit and time of wakefulness and leaving hospital were significantly better than those of group M.In IKD,the MAP of1min after medicine given was somewhat lower than that of group C and M,but which had not any statistical significance.As for HR and SpO2,patients in3groups all were normal. Conclusion Small dosage imidazole diazepam-Ketamine-disoprofol anesthesia could not only significantly improve seˉdation or analgesic and amnesia effect,but its wakefulness time was shorter than that of imidazole diazepam as well.Thus IKD could be applied safely in gastroscopy in out patient department.