地佐辛与芬太尼分别联合咪达唑仑用于无痛结肠镜镇痛的效果比较

目的探讨阿片类镇痛药物地佐辛联合咪达唑仑用于无痛结肠镜静脉麻醉的镇痛效果与安全性。方法选取接受无痛结肠镜检查的成年患者120例，按随机数字表随机分为地佐辛组与芬太尼组，每组60例。2组均先给予咪达唑仑0.03 mg/kg缓慢静脉推注，然后地佐辛组缓慢推注地佐辛5.0～7.5 mg，芬太尼组缓慢推注芬太尼0.05～0.1 mg，在患者麻醉至Ramsay镇静分级4级后行结肠镜检查。在术后不同时间点（术后第10、20、30分钟）进行镇痛视觉模拟评分（VAS），监测记录检查时间、患者心率、平均动脉压、血氧饱和度的变化及不良反应发生率。结果2组患者均安静顺利完成检查，术中各项生命体征稳定，未出现呼吸抑制、呼吸停止及心搏骤停等不良反应。患者术后无明显不良记忆，地佐辛组和芬太尼组术后各时间点（术后第10 、20、30 min分钟）VAS评分比较差异均无统计学意义［1.2±0.6 比1.3±0.5，t=-0.667；1.1±0.3比1.0±0.7，t=0.685，1.0±0.2比1.0±0.3；t=-0.377］（均P〉 0.05）。但地佐辛组头晕、恶心呕吐、皮肤瘙痒等不良反应发生率（11.7%，7/60）明显低于芬太尼组的26.7%（18/60）（P〈0.05），芬太尼组患者发生呛咳1例。结论咪达唑仑联合地佐辛用于无痛结肠镜静脉麻醉，镇痛效果确切，不良反应发生率低，是一种安全、有效的麻醉方法。

Sedation with midazolam and dezocine versus midazolam and fentanyl for painless colonoscopy

ObjectiveTo investigate the analgesic effect and safety of dezocine used for intravenous anesthesia combined with midazolam in painless colonoscopy. MethodsOne hundred and twenty adult patients underwent painless colonoscopy at our hospital were included in the study. Patients were randomly and equally assigned to two groups： dezocine group and fentanyl group. All patients received 0.03 mg/kg midazolam intravenously first. Then patients in dezocine group were slowly injected with 5 7.5 mg dezocine intravenously and 0.05 0.1 mg fentanyl were administered intravenously to patients in fentanyl group before examination. The procedure start when patients reached level of 4 （Ramsay sedation scale score）. The standard visual analog scales （VAS） were recorded and compared between two groups at different time points after the procedure to rate the degree of pain. Heart rate （HR）, peripheral oxygen saturation （SpO2） and mean arterial pressure （MAP） as well as the side effects were also recorded and compared.Results All patients completed colonoscopy successfully without discomfort and serious complications. There were no statistically significant differences of VAS pain score between dezocine group and fentanyl group at different time points（10,20,30 minutes） after the procedure1.2±0.6 vs 1.3±0.5,t=-0.667;1.1±0.3 vs 1.0±0.7,t=0.685,1.0±0.2 vs 1.0±0.3;t= 0.377] （all P〉0.05）. However, the incidence of side effects of fentanyl group including nausea, vomiting, vertigo, bucking and pruritus was significantly higher than dezocine group26.7%（18/60） vs 11.7%（7/60）]（P〈0.05）. ConclusionIntravenously administered midazolam and dezocine has less adverse reactions compared with midazolam combined with fentanyl during painless colonoscopy.