笑气、咪达唑仑与芬太尼联用在无痛胃肠镜检查中的应用效果

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摘要目的探讨笑气、咪达唑仑与芬太尼联用在无痛胃肠镜检查中的应用效果。方法选取2016年8月—2017年8月深圳市龙华区人民医院240 例接受胃肠镜检查的患者作为研究对象，按照患者接受胃肠镜检查的方法分为胃镜组（120 例）与肠镜组（120 例）。胃镜组按照随机数字表法分为P 组、X 组、MF 组和MFX 组，每组各30 例；肠镜组按照随机数字表法分为P′组、X′组、MF′组和MFX′组，每组各30 例。P 组和P′组采用普通内镜检查，X 组和X′组采用笑气镇静，MF 组和MF′组采用咪达唑仑联合芬太尼镇静，MFX 组和MFX′组采用笑气、咪达唑仑与芬太尼联合镇静。分别比较胃镜和肠镜四组患者的心率（HR）、血压、血氧饱和度（SpO2）的变化，镇静效果以及胃镜检查的不良事件，结肠镜检查的疼痛程度。结果 ①胃镜检查，四组检查中的HR、收缩压（SBP）、舒张压（DBP）均高于检查前，SpO2 低于检查前，差异有统计学意义（P<0.05），四组检查后HR、SBP、DBP、SpO2 均能恢复到检查前水平；MFX 组的镇静效果优于MF 组和X 组，差异有统计学意义（P＜0.05）；X 组、MF 组和MFX 组的不良事件发生率均少于P 组，差异有统计学意义（P<0.05）。②结肠镜检查，P′组检查中的HR 高于检查前，差异有统计学意义（P<0.05），各组检查中的SBP、DBP 和SpO2 与检查前比较，差异无统计学意义（P>0.05），检查后均能恢复到检查前水平；X′组、MF′组和MFX′组的镇静效果比较，差异无统计学意义（P>0.05）；MF′组和MFX′组的镇痛有效率高于P′组，差异有统计学意义（P<0.05）。结论在无痛胃肠镜检查中，联用笑气、咪达唑仑、芬太尼具有良好的镇静镇痛效果，临床值得推广。

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	李俊达
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	申建刚
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	李若群
	付朝霞
	胡先福

关键词 ：笑气, 咪达唑仑, 芬太尼, 无痛胃肠镜

Abstract：Objective To investigate the application effect of Nitrous Oxide, Midazolam and Fentanyl in painless gastroenteroscopy. Methods A total of 240 patients who received gastro-colonoscopy in Longhua District People′s Hospital of Shenzhen from August 2016 to August 2017 were selected as the research subjects. According to the method of gastro-colonoscopy, the patients were divided into gastroscopy group (120 cases) and colonoscopy group (120 cases). Gastroscopy group was divided into P group, X group, MF group and MFX group according to random number table method, with 30 cases in each group. Colonoscopy group was divided into P′ group, X′ group, MF′group and MFX′group according to random number table method, with 30 cases in each group. Group P and P′received general endoscopy, group X and X′ received Nitrous Oxide sedation, group MF and MF′received Midazolam combined with Fentanyl sedation, and group MFX and group MFX′ received Nitrous Oxide combined with Midazolam and Fentanyl sedation. The changes of heart rate (HR), blood pressure,blood oxygen saturation (SpO2), sedative effect, adverse events of gastroscopy and pain degree of colonoscopy were compared between four groups respectively of gastroscopy and colonoscopy. Results ①In gastroscopy, HR, SBP and DBP in the four groups were higher than before, and SpO2 was lower than before, the differences were statistically significant (P<0.05). HR, SBP, DBP and SpO2 in the four groups all recovered to their pre-inspection levels. The sedative effect of MFX group was better than that of MF group and X group, the difference was statistically significant (P<0.05). The incidence of adverse events in group X, MF and MFX was lower than that in group P, the difference was statistically significant (P<0.008). ②In colonoscopy, HR in P′group was higher than before, the difference was statistically significant (P<0.05). There was no significant difference in SBP, DBP and SpO2 in each group (P>0.05), and they all recovered to the pre-examination level after examination. There was no significant difference in the sedative effect of X′group, MF′ group and MFX′group (P>0.05). The analgesic efficiency of MF′group and MFX′ group was higher than that of P′group, the differences were statistically significant (P<0.008). Conclusion In painless gastroenteroscopy, the combination of Nitrous Oxide, Midazolam and Fentanyl has a good sedative and analgesic effect, which is worth popularizing clinically.

Key words： Nitrous Oxide Midazolam Fentanyl Painless gastroenteroscopy

基金资助:广东省深圳市龙华新区科技创新资金项目（20150 924A1030112）

作者简介: 李俊达（1962-），男，广东揭西人，主任医师，科主任，主要从事消化系统疾病的诊治工作

引用本文:

李俊达；董思超；杨如霄；申建刚；黄锦文；李若群；付朝霞；胡先福. 笑气、咪达唑仑与芬太尼联用在无痛胃肠镜检查中的应用效果[J]. 中国当代医药, 2021, 28(21): 144-148.
LI Jun-da；DONG Si-chao；YANG Ru-xiao； SHEN Jian-gang； HUANG Jin-wen； LI Ruo-qun；FU Zhao-xia； HU Xian-fu. Application effect of Nitrous Oxide, Midazolam combined with Fentanyl in painless gastroenteroscopy. 中国当代医药, 2021, 28(21): 144-148.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I21/144

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