咪达唑仑复合瑞芬太尼在无痛胃镜检查中的应用研究#

摘要

目的：探讨咪达唑仑复合瑞芬太尼在无痛胃镜检查中的应用效果及安全性。方法：采用随机数值表法将我院门诊2013年3月至2013年7月行无痛胃镜检查的90例ASAI～II级患者分为实验组和对照组各45例，实验组和对照组均静脉注射咪达唑仑，其中实验组缓慢静推瑞芬太尼，并微泵持续输注瑞芬太尼；对照组则静脉缓慢注射氯胺酮，并持续泵入。观察并记录5组不同给药时间的收缩压（SBP）、舒张压（DBP）、心率（HR）、血氧饱和度（SpO2）的变化及不良反应的发生情况。结果：SpO2在各时刻组间及组内比较均无显著变化。实验组患者的SBP、DBP、HR在T2时刻与T1时刻比较显著下降（P＜0.05），T3、T4、T5时刻与T1时刻比较无显著差异；对照组SBP、DBP、HR在T2、T5时刻与T1时刻比较无显著变化，但在T3、T4时刻与T1时刻比较明显升高。同时组间比较，在T2、T3、T4时刻对照组的SBP、DBP、HR显著高于实验组（P＜0.05）。两组入睡时间比较无显著差异、实验组苏醒时间显著低于对照组(P＜0.05)；两组患者的镜检时间、离院时间差异不显著（P＞0.05）。实验组的心率减慢率显著高于对照组，术后躁动率显著低于对照组，两组患者的呼吸抑制率、呛咳率、喉痉挛发生率差异不显著（P＞0.05）。结论：咪达唑仑复合瑞芬太尼在无痛胃镜检查中较咪达唑仑复合氯胺酮循环更稳定，患者安静配合，检查后苏醒恢复时间短，苏醒彻底、无躁动。%Objective: To explore the application effect of midazolam and remifentanil in painless gastroscopy and safety.Methods:Using a random number table method will be 90 cases of grade ASAI~II patients in outpatient department of our hospital in 2013 March to 2013 July for gastroscopy were divided into experimental group and control group with 45 cases in each group, the experimental group and the control group were intravenous midazolam, the experimental group slowly intravenous remifentanil, and micro pump infusion remifentanil; control group, intravenous injection of ketamine, and continued to pump into the. Observe and record the 5 groups of different administration time of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), oxygen saturation (SpO2) changes and adverse reaction of the situation.Results:The SpO2 in the time between group and within group comparisons showed no significant changes. Patients in the experimental group SBP, DBP, HR in T2 time and T1 time was significantly lower than that (P<0.05), there was no significant difference of T3, T4, T5 moment and T1 moment; control group SBP, DBP, HR in T2,T5 moment and T1 moment and there is no significant change, but in T3, T4 moment and T1 time significantly increased. At the same time comparison between groups was significantly higher than that in the experimental group, T2, T3, T4 time control group SBP, DBP, HR (P<0.05).There is no significant difference between the two groups, sleep time of experimental group recovery time was significantly lower than the control group (P<0.05);examination time, two groups of patients leave hospital time difference was not significant (P>0.05). The heart rate slowed down the rate of the experimental group was significantly higher than that in control group, postoperative agitation rate was significantly lower than that of the control group, the two groups of patients with respiratory inhibition rate, the rate of cough, laryngeal spasm was not significant difference (P>0.05).Conclusion:Midazolam and remifentanil in painless gastroscopy with midazolam combined with ketamine in patients with loop more stable,quiet,after examining the recovery time is short, wake up completely, restlessness.