两种不同镇静方法在冠状动脉造影检查中对意识与血流动力学影响的对照研究  

Comparison of midazolam with or without fentanyl for conscious sedation and hemodynamics in coronary angiography

作　　者：张雅慧[1] 向小平[1] 章强[1] 卢记明[1] 

机构地区：[1]北京市第六医院麻醉科,100007

出　　处：《实用诊断与治疗杂志》2005年第3期157-159,共3页Journal of Practical Diagnosis and Therapy

摘　　要：目的 :评价咪唑安定与咪唑安定复合芬太尼在冠状动脉造影检查术中对意识镇静与血流动力学方面的影响。方法 :60例拟行冠脉造影的冠心病病人随机双盲分为咪唑安定组 (A组 ) ,咪唑安定 +芬太尼组 (B组 ) ,生理盐水组(C组 )。分别观察用药前、用药后 5min、造影前、置管时、造影结束后 2h的血压、脉搏、血氧饱和度 ,并记录镇静程度对操作的遗忘程度及术后的心理状况。结果 :A组和B组的血流动力学较C组明显平稳 ,A组和B组在镇静评分和焦虑评分 ,对操作的遗忘评分 ,满意评分等方面无明显差别。结论 :咪唑安定和咪唑安定复合芬太尼两种方法在冠状动脉造影检查中 ,都能取得意识镇静 ,遗忘的满意效果 ,并且患者能按术者要求配合操做 ,血流动力学平稳。在同样的过程中未采取镇静措施而仅仅给予局部麻醉的患者无一例外的都出现了血压升高等不良反应。由此也可以看出在冠心病病人冠状动脉造影检查中引起血流动力学波动的原因是焦虑紧张而不是疼痛。Objective To compare the hemodynamic and sedative effects of midazolam with or without fentanyl combination with placebo in coronary angiography. Methods Sixty patients who were suspected coronary artery disease, ASA grade 3～4,were randomly divided into three groups,0.07 mg/kg midazolam in group A(n=20), 0.07 mg/kg midazolam+2 ug/kg fentanyl in group B (n=20),an equal volume of 0.9% sodium chloride in group C(n=20).Results Hemodynamic stability was better in group A and B than in group C. Sedation scores, anxiolysis, and patients' and cardiologists' satisfaction were not different between group A and B.Conclusion Both techniques of conscious sedation-midazolam and midazolam with fentanyl are satisfactory for coronary angiography and hemodynamic stability and patients' cooperation can be achieved. In such procedures, local anesthesia without sedation may lead to hypertension and increase overall morbidity.

关 键 词：冠状动脉造影 冠心病 咪唑安定 镇静 血流动力学 

分 类 号：R614[医药卫生—麻醉学]