异丙酚复合咪达唑仑静脉麻醉在小儿镇静性上消化道内镜术中的应用

目的：探讨异丙酚复合咪达唑仑静脉麻醉在小儿上消化道内镜术中的应用特点。方法：ASA I~II级接受无痛胃镜的497例患者分为小儿组243例（年龄2~14岁）及成人组254例（年龄18~65岁），2组内镜检查前均予咪达唑仑（0.02～0.03 mg／kg ）及异丙酚（0.6～0.7 mg/s）静脉推注，2种药物间隔时间为3~5 min，待进入浅睡眠状态、肌肉松驰、睫毛反射消失开始进镜。分别观察术前配合情况、给药时的反应、异丙酚用量、术中反应、清醒时间、术前、术中、术后脉氧饱和度（SpO2），心率（HR），呼吸（R），血压（BP）的变化。由操作者评估两组镇静质量。结果：小儿组术前自觉配合率低，给药后2组病人均达到较好的镇静状态。小儿组异丙酚推注过程中躁动妄语率、SpO2一过性下降率、每公斤体质量异丙酚用量、清醒时间［（分别为82.7%，17%，2.4 mg/kg，(17.5±3.2)min）］均明显高于成人组［分别为9%，4%，1.4 mg/kg，(9.5±1.3)min， P＜0.01）］。用药后2组HR与BP均有不同程度下降，但术后均能迅速恢复，组间比较差异无统计学意义（P＞0.05）。结论：用异丙酚复合咪达唑仑对小儿实施镇静性上消化道内镜术安全、有效。

Propofol combined with midazolam intravenous sedation anesthesia in pediatric upper gastrointestinal endoscopy

Objective To explore the application of propofol combined with midazolam intrave-nous anesthesia in pediatric upper gastrointestinal endoscopy, Methods A total of 497 ASA Ⅰ～Ⅱ patients who received sedative upper gastrointestinal endoscopy were assigned to a children group (2～14 years) and an adults group (18～65 years). The 2 groups were treated with midazolam (0.02～0.03 mg/kg, iv) and propofol (0.6～0.7 mg/s, iv) with an interval of 3～5 minutes. Enterseopy was inserted at light sleep, relaxing muscles, and disappearance of eyelash relaxation. Combining of pro-endoscopy, reaction to intravenous administration, dose of propofol, reaction to en-doscopy, time of returning to consciousness, changes of SpO2, R, HR, and BP, and sedative quali-ty were evaluated. Results Good sedation of the 2 groups after intravenous administration was ob-served. Rate of combining of pro-endoscopy in children was lower (42%) than that in adults (100%). The incidence of restlessness, hyperphasia, temporary decreasing of SpO2, dose of propofol of per kilogram weight, time of returning to consciousness in the children were 82.7%, 17%, 2.4 mg/kg, and (17.5±3.2)min, respectively, which were all higher in the adults 9%,4%,1.4 mg/kg, and (9.5±1.3)min, P<0.01]. HR and BP decreased in the 2 groups, and recovered rapidly after the endoscopy. There was no significant difference between the 2 groups (P>0.05). Conclusion It is safe and effective to use propofol combined with midazolam intravenous sedation anesthesia in pediatric upper gastrointestinal endoscopy.