三联药在无痛肠镜检查和治疗中的应用  

The clinical observation of propofol combination with midazolam and fentanyl used in painless enteroscopy

作　　者：钱耀亮[1] 陈金生[1] 黄乔东[1] 卢振和[1] 高崇荣[1] 

机构地区：[1]广州医学院第二附属医院,广东广州510260

出　　处：《中国医院药学杂志》2006年第4期435-437,共3页Chinese Journal of Hospital Pharmacy

摘　　要：目的：比较丙泊酚复合小剂量咪达唑仑和芬太尼与单用丙泊酚在无痛结肠镜捡及治疗中的镇静镇痛效果、不良反应，为无痛肠镜检查提供选择较好的药物配伍方法。方法：120例ASAⅠ～Ⅱ级拟行肠镜检查及治疗患者，随机分为两组，每组60例：A组（丙泊酚＋咪这唑仑＋芬太尼组），用药方法：首先依次缓慢静脉注射咪达唑仑0．01～0．02mg·kg^-1及芬太尼0．5～1．0μg·kg^-1。然后缓慢静脉注射丙泊酚0．6～1．0mg·kg^-1；B组（丙泊酚组），用药方法：缓慢静脉注射丙泊酚2．0～2．5mg·kg^-1。两组均待患者进入睡眠状态，时呼唤反应迟钝后。即可进镜，术中酌情追加少量丙泊酚。记录用药前、用药后2min及手术结束时的心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2），丙泊酚用量，术中镇静评分（OAA／S评分）及苏醒时间。结果：两组年龄、体重、用药前及手术结束时HR、MAP、SpO2，OAA／S评分及手术时间组间比较差异无显著性（P〉0．05）；B组在用药后2min HR、MAP、SpO2均出现下降，与用药前、手术结束时及A组比较差异无显著性（P〉0．05）；A组的丙泊酚用量为（82．3±13．2）mg，B组用量为（152．4±24．6）mg，组间比较差异有极显著性（P〈0．01）；A组苏醒时间为（1．61±0．25）min，B组为（3．6±0．3）min，组间比较差异有极显著性（P〈0．01）。结论：丙泊酚配伍小剂量咪达唑仑和芬太尼镇静镇痛效果好，苏醒迅速，无明显不良反应，是一种较好的无痛肠镜药物配伍方法。OBJECTIVE To find a better drug combination method by comparing the analgesia/sedation effect and side effects of propofol combination with midazolam and fentanyl with that of propofol used in painless enteroscopy. METHODS 120 patients were randomly divided into two groups： In group A（n = 60）,0. 01 - 0. 02 mg·kg^-1midazolam and 0. 5 - 1.0μg·kg^-1 fentanyl were slowly injected intravenously,followed by 0. 6 - 1.0 mg·kg^-1 propofol. In group B（n = 60） ,2. 0 - 2. 5 mg·kg^-1 propofol was slowly administered intravenously. Low dose propofol was added during the operation when necessary. HR, MAP, SpO2, the dose of propofol, OAA/S scale, the time of examination and recovery were recorded. RESULTS The differences of age,weight,examination time, OAA/S and HR, MAP, SpO2 before drug administration between the two groups were not significant（P〉0. 05） ; HR, MAP and SpO2 decreased 2 minutes after drug administration in group B,The differences were not significant compared to that before drug administration and that in group A（P〉0.05）. The average dose of propofol was （82.3± 13. 2）mg in group A, and it was （152. 4 ± 24. 6）mg in group B, there were significant differences between the two groups（P〈0.01 ）. The recovery time was （ 1.61 ± 0.25）min, （3.56 ± 0. 34）min in group A and group B respectively, there were significant differences between them（ P〈0. 01 ）. CONCLUSION Propofol combination with midazolam and fentanyl could offer a good sedation/analgesia effect,and had no evident side effects. It is a good drug combination method.

关 键 词：丙泊酚 咪达唑仑 芬太尼 肠镜 镇痛 

分 类 号：R969.4[医药卫生—药理学]