【摘要】 目的 研究静脉麻醉药咪唑安定和异丙酚联合应用于内镜检查中的可行性和安全性。方法 ASAⅡ级以下，镇静组胃镜检查者60例、结肠镜检查者36例，同期普通胃镜60例、肠镜36例为对照组；观察在静脉麻醉下生命体征的变化、 镇静效果分级、并发症发生率以及用药总量、检查后清醒时间和离室时间，并与对照组比较。结果 镇静组效果分级在4～5级，对内镜操作无记忆，且在进境、退镜时血压、心率与入室时基本无异，而对照组在进镜时血压、心率有明显升高；两组比较差异有显著性（P<0.05）。镇静组恶心呕吐、咳嗽、躁动、咽部不适发生率分别为0、8.3%、10%、0，而对照组分别为38%、1.7%、28%、24%；镇静组清醒时间为(7.86±2.21) min,术毕室内留滞时间为(18.25±3.56) min，而对照组室内留滞时间为(5.12±1.32) min；胃镜总用药量咪唑安定(2±0.25) mg，异丙酚(100±20) mg；肠镜用药量咪唑安定(2±0.25) mg，异丙酚(150±30) mg。结论 静脉麻醉下的内镜检查是操作简单、安全可行的，其术毕室内留滞时间较普通内镜检查稍长, 应由经验丰富的麻醉医师和内镜检查医师合作完成，检查室内应常规配备急救药品和器械，以确保安全。 【关键词】 静脉全麻； 咪唑安定； 异丙酚； 胃镜； 肠镜 Abstract:Objective Studying the feasibility and safety of joint application of midazolam and propofol during endoscopic procedures. Methods ASAⅡ class below, 60 cases of gastroscopy and 36 cases of colonscopy in sedative group were administered with intravenous midazolam and propofol, in controlling group, 60 cases of gastroscopy and 30 cases of colonscopy were treated with routine procedures; the changes of blood pressure (BP), heart rate (HR), pulse oxygen saturation(SpO2), the grade of sedation effect, the rate of complications (respiratory depression, blood pressure descendent, nausea, vomiting, cough and restlessness), total dose, the time of waking (eye opening in response, can answer question) the time of leaving room in sedative group were compared with controlling group . Result In sedative group, the grade of sedation effect is in 4 ～5 classes, with no memory of examination, inserting and withdrawing of the endoscopes, the change of blood pressure, and heart rate were slight. But in controlling group, blood pressure and heart rate go up obviously during examination. Comparison of the two groups （P<0.05）showed significant statistic difference. The incidence of nausea and vomiting , cough , restlessness, swallow discomfort in sedative group (0, 8.3%,10%, and 0% respectively) were remarkable lower than those in the control group (38%, 17%, 28%, and 24% respectively, P<0.05); In sedative group, awaking time was (7.86±2.21) min, the indoor staying time was 18.25±3.56 min, but in the controlled group, indoor staying time was (5?12±1.32) min; Gross dosage for gastroscopy: midazolam (2±0.25) mg，propofol (100±20) mg；and gross dosage for colonscopy: midazolam (2±0.25) mg，propofol (150±30) mg.Conclusion Endoscopic procedures under intravenous anesthesia was simple and safe. And the indoor staying time was slightly longer. It should be finished cooperatively by experienced clinical physicians. First aid drugs and apparatus should be prepared to insure the safety. Key words: intravenous anesthesia; midazolam; propofol; gastroscopy; colonscopy 随着人们物质生活的改善和对生活质量要求的提高，近年来对于常规的消化道内镜检查，“无痛”已成为患者能接受该项检查或治疗的首要条件，这给以“起效迅速苏醒快”为优势的静脉麻醉开辟了新的业务空间。本研究采用咪唑安定和异丙酚配伍应用于内镜检查的患者，观察术中呼吸、循环指标以及术后清醒时间，并与同期普通内镜检查进行对照，现报告如下。 1 资料与方法 1．1 一般资料 96例要求接受“无痛”内镜检查的患者，其中胃镜60 例，肠镜36 例；男69 例，女27 例，年龄15～79岁。ASA分级Ⅱ级以下。随机选择同期普通内镜检查患者96例，胃镜60例，肠镜36例为对照组。 1．2 方法 患者治疗前均经过胃肠道准备，排除禁忌证；麻醉医师常规访视病人，作出评估；年龄大于60岁者做心电图检查排除心血管系统疾患。患者入室后开放静脉、接三通；常规测血压、氧饱和度，进行心电监护。在静脉开放后即给予阿托品0.25 mg，其目的是止泌、减少胃肠蠕动、预防性提升心率；根据需要摆放体位，鼻导管给氧，静脉给予咪唑安定(0.02～0.06)mg/kg(徐州恩华药业产)，缓慢静注，注速1 mg/30 s，然后给异丙酚(1～1.5) mg/kg（美国雅培产），作为首量，快速静脉补液；观察患者，待出现睫毛反射消失，呼之不应，呼吸、心率、血压等基本平稳时可插镜操作，术中根 |