羟考酮与舒芬太尼联合咪达唑仑在无痛结肠镜检查中的应用比较

Comparison of the application of midazolam plus oxycodone versus midazolam plus sufentanil in painless colonoscopy

摘要:

目的 比较羟考酮联合咪达唑仑与舒芬太尼联合咪达唑仑在无痛结肠镜检查中的麻醉效果、安全性及副作用。方法 选择无痛结肠镜检查患者60例，按随机数字表随机分为两组。年龄18～65岁；体质指数18.5～27.0 kg/m²；美国麻醉医师协会（ASA）分级Ⅰ～Ⅲ级。所有患者在无痛结肠镜检查前5 min静脉注射咪达唑仑0.05 mg/kg。然后O组（羟考酮组）给予0.10 mg/kg羟考酮，S组（舒芬太尼组）给予0.10 μg/kg舒芬太尼，操作过程中可根据患者检查配合情况，适当追加丙泊酚静注10～30 mg/次。所有患者均连续监测血氧饱和度、心率以及无创血压。记录药物起效时间、操作时间、复苏时间和出院时间。记录低血压、血氧饱和度降低、恶心和呕吐等不良反应。记录麻醉医师满意度、消化内科医师（操作人员）满意度、术后1周患者满意度。结果 两组患者药物起效时间、操作时间、复苏时间、离室时间、低血压、重度缺氧的发生率比较，差异均无统计学意义（P > 0.05），S组的丙泊酚追加率明显高于O组（P < 0.05），轻度血氧饱和度降低的发生率明显高于O组（P < 0.05），消化内科医生满意度低于O组（P < 0.05），麻醉医师满意度低于O组（P < 0.05）。两组患者满意度比较，差异无统计学意义（P > 0.05）。结论 羟考酮联合咪达唑仑用于门诊无痛结肠镜检查安全有效，较舒芬太尼联合咪达唑仑术中轻度低氧血症发生率和丙泊酚添加率低。

Abstract:

Objective To compare the anesthetic effect, safety and side effects of oxycodone plus midazolam versus sufentanil plus midazolam in painless colonoscopy.Methods 60 patients underwent painless colonoscopy were randomly divided into two groups according to the random number table. Age: 18～65 years old; Body mass index: 18.5～27.0 kg/m²; ASA Ⅰ～Ⅲ level. Five minutes before colonoscopy, all the patients received slowly intravenous injection of midazolam 0.05 mg/kg. Then, group O (oxycodone group) was given 0.10 mg/kg oxycodone, and group S (sufentanil group) was given 0.10 μg/kg sufentanil. During the operation, propofol intravenous injection of 10～30 mg could be administered according to the patient's examination and cooperation. Heart rate, noninvasive blood pressure and oxygen saturation were continuously monitored. Induction time, operation time, resuscitation time and Time-out of operating room were recorded. Adverse reactions such as hypotension, hypoxia saturation, nausea and vomiting were recorded. Anesthesiologist satisfaction immediately, gastroenterologist (operator) satisfaction immediately, and patient satisfaction one week after the operation were recorded.Results Induction time, operation time, resuscitation time, Time-out of operating room, the incidence of hypotension, severe hypoxemia there was no significant difference between the two groups (P > 0.05), the group S of propofol additional rate significantly greater than the O group (P < 0.05). The incidence of mild hypoxemia in S group was obviously higher than that of O group (P < 0.05). Digestive physician satisfaction in S group is signficantly lower than that of the O group (P < 0.05); Satisfaction of anesthesiologists in group S was obviously lower than that in group O (P < 0.05). There was no significant difference in patient satisfaction between the two groups (P > 0.05).Conclusion Oxycodone combined with midazolam is safe and effective in outpatient colonoscopy, has a lower incidence of mild hypoxemia and the addition of propofol than sufentanil combined with midazolam.