孙丽平¹，李波¹，孙远杰²

（吉林大学第四医院1. 麻醉科; 2. 消化内科, 吉林 长春 130011）

摘要：目的 研究对比单纯咪唑安定及其复合芬太尼用于纤维胃、肠镜检查的临床麻醉效果和安全性。方法 要求行无痛胃、肠镜检查的患者400例，随机均分为两组，咪唑安定组(M)；咪唑安定复合芬太尼组(MF)。MF组先静注芬太尼0.05-0.1毫克，然后与M组相同缓慢静推咪唑安定(0.5毫克/毫升)至无睫毛反射，开始操作，若病人述疼，MF组静注芬太尼，M组静推咪唑安定。监测并记录两组注药前、注药后1分钟、5分钟、15分钟、操作结束时，各点的SBP、SP0₂、HR、RR；记录两组咪唑安定总量，MF组芬太尼总量；两组镇痛效果，肢动情况，清醒后遗忘程度及不良反应。操作结束时，均静推氟马西尼至清醒为止。结果 操作中1分、5分、SP0₂、SBP、RR与操作前比较有显著性差异(P<0.05)，操作中值明显低于操作前值；咪唑安定总量MF组明显低于M组(P<0.01)；两组肢动发生率MF组(5%)明显低于M组(13%);两组呼吸抑制(SP0₂<90%)发生率MF(12%)，M(11%)无显著性差异(P>0.05)。结论 两种药物联合应用(咪唑安定复合芬太尼)更适合纤维胃、肠镜检查。

关键词：咪达唑仑；芬太尼；胃、肠镜检查

中图分类号：R971.2; R443.8             文献标识码： A

A clinical comparison between midazolam and its combination with

             fentany on painless endoscopy

SUN Li-ping¹,  LI Bo,¹  SUN Yuan-Jie²

(1.    Department of Anesthesia; 2. Department of Gastroenterology, the Fourth Hospital of Jilin University, Changchun , Jilin 130011, P. R. China)

Abstract: Objective: To study and compare the clinical efficacy and its safety. Methods: 400 cases patients receiving painless fiberoscopic check of stomach and bowels were randomly divided into two groups as midazolam group (M) and its combination with fentany (MF). At first, MF was given fantasy through intravenous distilling with dosage of  0.05 to 0.1 miligram, then midazolam (0.5mg/ml) would be given to both groups by slow infusion until no ciliary’s reflex appeared, if patient complained painful at the early phase of operation, then fentany was used in MF group and midazolam in M group. Monitor and record SBP 、SPO₂ 、HR、RR of both groups during the following phase as 1、 5 、15 minutes after injection, also the same way to the end of operation., the total amount of midazolam for the two groups, total fentany dosage for MF group. Analgesic effect, body movement, forgetfulness and harmful reaction after being sober of both groups were also screened. When all managements were finished, both groups were injected flumazenil until patients turned to awake. Results: There was significant difference between preparation and at 1 and 5 minutes after operation in SPO₂ 、 SBP 、RR (P<0.05), the value during operation slowed dramatic decrease compared with that of preparation; The total amount of milazolam of MF group was greatly lower than that of M group (P<0.05); MF group (5%) was greatly lower than that of M group (13%) in occurrence rate of body movement (P<0.05); Also it showed the same circumstance towards the occurrence of both groups MF(12%) and M (11%), but no striking difference happened in occurrence rate of respiratory inhibition (SPO₂<90%) (P>0.05). Conclusion: Satisfactory result could be acquired by the combination of milazolam and fentany for the cheek of stomach and bowels.