| Objective: To investigate the effects of midazolam combined with dezocine for anesthesia of painless gastrointestinal endoscopy.Methods: We use 120 patients in our hospital receiving painless gastroscopy and colonoscopy patients were divided into 4 groups, group I and group II for painless gastroscopy group, 40 patients in each group, group III and IV for painless colonoscopy group, 20 patients in each group.Patients with painless gastroscopy anesthesia before fasting, forbidden to drink 8 hours; Painless colonoscopy patients before 6 hours of polyethylene glycol electrolyte powder(trade name:He Shuang) intestinal cleaning.After entering the endoscopy room ready: right upper limb vein channel opens; monitoring of heart rate, blood pressure(left upper limb), oxygen saturation; in the left lateral decubitus position, oxygen 3-5L/min. group I, the and group III intravenous injection of propofol 1.5mg/kg slowly into the, check patients body movement when additional propofol 0.5 mg / kg, II group and IV group combined with intravenous injection of midazolam of midazolam 0.05 mg / kg diluted after intravenous injection, injection speed 1mg / the min, if necessary, additional 0.5-2mg, dezocine 0.1 mg / kg static push.Note the drug process was observed in each group were examined, to be the disappearance of the eyelashes to be checked for operation.Intraoperative systolic blood pressure < 80 mm Hg when given ephedrine 10 mg, heart rate < 50 beats / min when given atropine 0.5mg, oxygen saturation < 90% when given under the care of facial mask ventilation or breathing air bag pressure assisted breathing treatment.After operation in groups II and IV were not immediately wake up push fluorine injection of flumazenil(0.2, 0.4 mg naloxone wake-up. Recovery after asking the patient nausea, dizziness and discomfort, patients from the hospital before assessment VAS score.(1) Preoperative, intraoperative and postoperative systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, blood oxygen saturation(2)Record hypotension(systolic blood pressure < 80 mm Hg), tachycardia(slow heart rate < 50 beats / min) and hypoxemia(Sp O2 < 90%), dynamic, nausea, vomiting, cough, injection pain occurrence(3)Were recorded in two groups of drug induction time(comment was administered to sedation grade 5), examination time, recovery time(the end of the examination to patients calling the goggle time), time away from the hospital time(from the hospital score greater than or equal to 9 points)(4)Records of midazolam, propofol and dezocine, drug costs, anesthesia fee(5) Record the postoperative nausea, vomiting, the incidence of the postoperative VAS score of dizziness and other adverse reactions.(6)Postoperative VAS scoreResult:(1)Blood pressure, blood oxygen, blood oxygen saturation: in the endoscopic group after administration of SBP, DBP, MAP decreased, the decline in the propofol group were greater than 15% less than 20%, the decrease in the midazolam group were less than 10%.In gastroscopy group, propofol group SBP, DBP, MAP lower than midazolam group SBP, DBP, MAP( 100.42±7.14± vs 110.27±6.78,P<0.0 1)( 67.62±7.48 vs 74.52±6.93,P<0.01)(78.56±6.41 vs 86.43±6.08,P<0.01).Colonoscopy group, propofol group, SBP, DBP, map below midazolam group, SBP, DBP, map(109.75±7.55 vs 115.90±4.98,P<0.05),(70.85±7.67 vs 77.40±4.10,P<0.05)( 83.03±7.27 vs 89.88±3.84,P<0.05);In the endoscopic group, the central rate of the propofol group and midazolam group was slightly decreased, and there was no statistical significance between the two groups;During the operation, the mean value of blood oxygen saturation was greater than 90%, and the decrease of propofol group was larger than that of the latter, and the two groups were statistically significant( 90.90 ± 8.53 vs 94.45 ± 2.07, P <0.05).Propofol group and midazolam group were slightly decreased colonoscopy group, there was no significant difference between the two groups.(2)Intraoperative adverse reactions: Gastroscope, I(c) and group II(MI) group of respiratory inhibition, bradycardia, pain on injection rate have statistically significant difference(P < 0.05) and I(c) and group II(MI) group hypotension compared, cough, dynamic no statistical difference(P > 0.05); intestinal mirror, III(C) group and IV(MI) group of respiratory depression, pain on injection rate have statistically significant difference(P < 0.05), group III(c) group and IV(MI) bradycardia, hypotension, cough, moving, no statistical difference(P > 0.05).(3)Induction time, examination time, recovery time, leave hospital time: Gastroscopy and I group(propofol) in awakening time, leave hospital time than II(midazolam midazolam combined with dezocine) group in recovery time, from the hospital in time for both have statistical significance(101.57±6.64 vs 92.52±4.86,P<0.05)(20.25±3.40 vs 17.62±2.28,P<0.05); two induction time and examination time compared with no statistical significance(120.67±5.57 vs 119.72±10.49,P>0.05)(4.1±0.95 vs 4.1±2.92,P>0.05). Colonoscopy and I group(propofol) in awakening time, leave hospital time than group II(midazolam combined with dezocine) recovery time, from the hospital in time for both have statistical significance(81.80±6.91 vs 73.55±9.37,P<0.05)(21.35±3.23 vs 15.20±2.14,P<0.05); two induction time, check the time compared no significant(114..50±7.82 vs 117.85±10.08,P>0.05)(14.10±1.80 vs 13.75±1.74,P>0.05)(4)Total cost comparison: in ordinary gastrointestinal endoscope based payment, propofol group required payment based anesthesia care fee Ermi of midazolam group does not need, and the difference is significant(5) Adverse reaction after operation, intraoperative awareness: gastroscopy and intestinal mirror, midazolam midazolam group as compared with propofol group, the postoperative dizziness, nausea, vomiting, incidence of no statistical significance, group II(MI) operation after the awareness rate is higher than group I(c) P<0.0.5. More than no statistical significance(6)VAS score after operation: there was no significant difference in the VAS scores between the midazolam group and the propofol group(P>0.05) in the gastroscopy and the bowelConclusion: Midazolam, dezocine used for painless gastrointestinal endoscopy hemodynamic stability, less adverse reaction, safe and effective, and no accidents happened, wake up quickiy, do not need to professional anesthesiologists to implement the drugs and full custody, more economical and practical work more convenient, Suitable for hospitals to promote the lack of anesthesia. |
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