| 摘要: |
| ［摘要］ 目的 观察小剂量咪达唑仑复合舒芬太尼在住院患者经食道超声心动图（TEE）检查中的应用效果。方法 采用前瞻性队列研究的方法，共纳入2017年2月至9月于河北医科大学第二医院行TEE检查的260例住院患者，分为单纯表面麻醉组（C组）54例，咪达唑仑组（M组）27例和咪达唑仑复合舒芬太尼组（MS组）179例。三组患者均给予丁卡因胶浆行口咽部表面麻醉，C组不作其他处理，M组静脉注射咪达唑仑0.03 mg/kg，MS组静脉注射咪达唑仑0.03 mg/kg并静脉注射舒芬太尼0.1 μg/kg。M组和MS组术中根据患者反应决定是否追加药物。记录三组患者入室后（T0）、探头置入成功时（T1）、探头置入成功后5 min（T2）的无创血压收缩压（NSBP）、心率(HR)和脉搏血氧饱和度(SpO2)，记录探头置入难易程度、TEE检查时间、术中不良事件、检查者满意度。检查结束后用改良Aldrete量表评分判断患者恢复程度。术后24 h随访患者对麻醉的满意度及术后不良反应发生情况。结果 三组探头置入难易程度、检查者满意度评分和患者术后对麻醉的满意度评分比较差异有统计学意义（P<0.05）。与C组同时间点比较，M组和MS组T1和T2时间点NSBP和SpO2降低，MS组T1和T2时间点HR降低，差异均有统计学意义（P<0.05）。与M组同时间点比较，MS组T2时间点SpO2降低，差异有统计学意义（P<0.05）。与T0时间点相比，C组T1和T2时间点HR升高，MS组的HR在T2时间点降低，M组和MS组T1和T2时间点NSBP降低，MS组T1和T2时间点SpO2降低，差异均有统计学意义（P<0.05）。三组术中不良事件发生率比较差异无统计学意义（P>0.05），均未出现需要处理的心动过缓和心动过速。C组患者术后恶心发生率显著高于M组和MS组，术后咽部不适发生率显著高于MS组（P<0.05）。术中不良事件和术后不良反应经及时处理后所有患者均恢复正常，无不良后果发生。结论 在表面麻醉的基础上，小剂量咪达唑仑、咪达唑仑复合舒芬太尼均可安全有效地应用于住院患者TEE检查中，咪达唑仑复合舒芬太尼的效果更佳，但需注意可能发生的低氧血症。 |
| 关键词: 咪达唑仑 舒芬太尼 经食道超声心动图 镇静 |
| DOI：10.3969/j.issn.1674-3806.2024.04.02 |
| 分类号:R 614 |
| 基金项目:河北省自然科学基金项目（编号：H2019206714） |
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| Observation on the application effects of low-dose midazolam combined with sufentanil on inpatients undergoing transesophageal echocardiography examination |
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LI Xuze1, WANG Jing2, FENG Rui2, ZHANG Chunxia2, YIN Hongning2, LIU Haitao1, KANG Rongtian1
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1.Department of Anesthesiology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China; 2.Department of Cardiac Ultrasound, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
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| Abstract: |
| ［Abstract］ Objective To observe the application effects of low-dose midazolam combined with sufentanil on inpatients undergoing transesophageal echocardiography(TEE) examination. Methods A total of 260 inpatients undergoing TEE examination in the Second Hospital of Hebei Medical University from February 2017 to September 2017 were included by adopting a prospective cohort study method. The inpatients were divided into simple topical anesthesia group(group C, 54 cases), midazolam group(group M, 27 cases) and midazolam combined with sufentanil group(group MS, 179 cases). All the patients in the three groups were given topical anesthesia using tetracaine plasmagel at the oropharynx. Group C was not given any other treatment. Group M was given intravenous injection of midazolam at dose of 0.03 mg/kg. Group MS was given intravenous injection of midazolam at dose of 0.03 mg/kg and intravenous injection of sufentanil at dose of 0.1 μg/kg. Group M and group MS were decided whether to add drugs during the operation based on the patients′ response. Non-invasive systolic blood pressure(NSBP), heart rate(HR), and pulse oxygen saturation(SpO2) were recorded in the three groups after the patients entered the examination room(T0), when the probes were successfully inserted(T1) and 5 minutes after successful probe insertion(T2). The difficulty of probe insertion, TEE examination time, intraoperative adverse events and examiners′ satisfaction were recorded. After examination, the modified Aldrete scale was used to judge the recovery degree of the patients. The patients were followed up for their degree of satisfaction with anesthesia and for the occurrence of postoperative adverse reactions 24 hours after surgery. Results There were significant differences among the three groups in the difficulty of probe insertion, examiners′ satisfaction scores and patients′ postoperative satisfaction with anesthesia scores(P<0.05). Compared with those in group C at the same time point, NSBP and SpO2 in group M and group MS at T1 and T2 time points were decreased, and HR in group MS at T1 and T2 time points was decreased, and the differences were statistically significant(P<0.05). Compared with that in group M at the same time point, SpO2 in group MS at T2 time point was decreased, and the difference was statistically significant(P<0.05). In group C, compared with that at T0 time point, HR was increased at T1 and T2 time points. In group MS, compared with that at T0 time point, HR was decreased at T2 time points. In group M and group MS, compared with that at T0 time point, NSBP was decreased at T1 and T2 time points. In group MS, compared with that at T0 time point, SpO2 was decreased at T1 and T2 time points. The differences were statistically significant(P<0.05).There were no significant differences in the incidence rates of intraoperative adverse events among the three groups(P>0.05), and the three groups did not experience any bradycardia and tachycardia that needed to be treated during surgery. The patients′ incidence rate of postoperative nausea in group C was significantly higher than that in group M and group MS, and the patients′ incidence rate of postoperative pharyngeal discomfort in group C was significantly higher than that in group MS(P<0.05). After timely treatment of intraoperative adverse events and postoperative adverse reactions, all the patients returned to normal, and no adverse consequences occurred. Conclusion On the basis of topical anesthesia, both low-dose midazolam and midazolam combined with sufentanil can be safely and effectively applied in hospitalized patients undergoing TEE examination, and midazolam combined with sufentanil has better effects, but attention should be paid to possible hypoxemia. |
| Key words: Midazolam Sufentanil Transesophageal echocardiography Sedation |
