芬太尼和咪达唑仑或异丙酚复合麻醉在老年人肠镜中的比较  

Fentanyl combined with midazolam or propofol for colonoscopy in elderly

作　　者：吴建维[1] 赖四海[1] 邹伟清[1] 林丽曼[1] 

机构地区：[1]深圳市宝安区人民医院,518101

出　　处：《现代消化及介入诊疗》2009年第2期74-76,共3页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的比较芬太尼和低剂量咪达唑仑或异丙酚两种复合麻醉在老年人肠镜检查的安全性及镇痛效果。方法80例老年患者,随机分为MF(芬太尼+咪达唑仑)组40例,PF(芬太尼+异丙酚)组40例。MF组检查前2 min静注咪达唑仑0.05 mg/kg、芬太尼1μg/kg;PF组静注芬太尼1μg/kg,然后缓慢静注异丙酚1 mg/kg,并以30 ml/h的速度持续静注;两组均施行单人操作肠镜检查。评估两组患者术前和术后恢复情况。结果MF组镇痛评分、镇静评分分别为1.3±0.6、3.8±0.5,PF组分别为0.5±0.2、5.9±0.7,苏醒时间分别为PF组(4.63±0.4)min、MF组(1.75±0.5)min,MF组优于PF组(P<0.05)。离院时间MF组(21±4.2)min,PF组为(16±3.4)min,PF组明显短于MF组(P<0.05)。插镜时间分别为MF组(6.7±1.6)min、PF组(9.2±1.1)min(P<0.05),MF组舒适度评分为9.4±0.5,PF组9.7±0.3,两组无明显差异(P>0.05)。两组检查中的SBP、HR、SpO2较检查前降低(P<0.05),其中PF组比MF组降低幅度大(P<0.05),PF组检查中发生呼吸抑制7例、心动过缓4例,经辅助呼吸、注射肾上腺素后很快恢复。结论咪达唑仑或异丙酚复合麻醉用于老年人肠镜检查均有较好的镇痛、镇静效果,其中低剂量咪达唑仑复合麻醉患者可依指令配合变动体位,而且对呼吸和循环系统影响较小,安全性较高。Objective To evaluate the sedative and analgesic effect and the safety of fentanyl combined with midazolam or propofol for colonoscopy in elderly patients. Methods Eighty .elderly patients were ran- domly divided into 2 groups： midazolam-fentanyl group （Group MF） and propofol-fentanyl group （Group PF）; colonoscopy was undergone by one doctor. The effect of sedation and analgesia, operation time, the reaction of patients, the blood pressure （MBP）, oxygen saturation value （SpO2）, and pulse and breath rates were observed. Results Analgesic and sedative effect were satisfactory in two groups. But Group PF was better than Group MF （P〈 0.05）. The operation time was shorter in Group MF[（6.7 ± 1.6）rain] than in Group PF[（9.2 ± 1. ]）mini. Patients showed a high percentage of comfort in two groups （Group MF 9.A ± 0.5,Group PF 9.7 ± 0.3, P 〉 0.05）. During operation, MBP, SpO2, and pulse were significantly lower in Group PF than in Group MF. Conclusion fentanyl-propofol or midazolam-fentany is effective in colonoscopy of elderly patients, but fentanyl- propofol is safer and superior to midazolam-fentang in the procedure.

关 键 词：肠镜检查 咪达唑仑 芬太尼 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R971.2[医药卫生—临床医学]