| Objective: To compare the safety and efficacy of midazolam or dexmedetomidine compound with fentanyl used in conscious sedation during endoscopic variceal ligation.Methods: We selected 63 patients in our hospital from March to December 2017.These patients were planed to have endoscopic esophageal varix ligation under conscious sedation.The patients were randomly divided into midazolam compound fentanyl group(group M,35)and dexmedetomidine compound fentanyl group(group D,35).There was no statistical difference in gender,age,weight,ASA classification and Child score between the patients in two groups(P > 0.05).All patients were fasting 8 hours before surgery,6 hours of water abstinence,and no preoperative medication.The patients were treated with surface anesthesia to the oral and throat areas 10 minutes before entering the operating room.The patients lay on the left side with the nasal catheterization(5L/min)and detection of dispectral index(BIS).The blood pressure,heart rate and blood oxygen saturation of the upper extremities were monitored.The operation of M group patients was performed 10 min after intravenous injection of 1 g/kg fentanyl and intravenous drip of 1?g/kg midazolam after 10 min.The operation of D group patients was performed 10 min after intravenous injection of 1 g/kg fentanyl and intravenous drip of 1?g/kg dexmedetomidine.If the patient moves or does not cooperate in the operation,he would take comfort from doctors.The operation was completed in 25-30 minutes by an experienced endoscopic doctor and a nurse.When the operation was finished,the patient was sent back to the ward after identified conscious and the vital signs were stable.The peripheral upper arm blood pressure MAP(mm Hg),heart rate,HR(times/min),blood oxygen saturation Sp O2 %(%)at their fingertip,the BIS value(0-100),Ramsay score(hereinafter referred to as R score),the number of cases like low oxygen concentration(< 90%),low blood pressure(< 90/60 mm Hg)and bradycardia(< 50 times/min)were recorded 7 times as before the operation(T0),5 minutes after drug delivery(T1),10 minutes after the drug delivery(T2),for the first time inserting endoscope(T3),the second time inserting endoscope(T4),ligation(T5),before back to ward(T6).Whether could be aroused during inserting endoscope,body movement during the operation(cough and hiccup without call),postoperative follow-up in 12 hours whether intraoperative forget,postoperative pain and satisfaction of patients and surgeons were also recorded.Results: Both groups completed the operation.There was no statistically significant difference between the two groups(P > 0.05).The systolic blood pressure of group D at T2(126.68±20.758),T3(125.40±19.691)is higher than that of group M at T2(111.11±18.828),T3(109.42±19.101)(P<0.05).The diastolic blood pressure of group D at T1(68.88±14.228),T3(69.68±14.062)is higher than that of group M at T1(61.87±17.053)and T3(60.68±14.023)(P<0.05).The blood pressure(systolic and diastolic blood pressure)in group D were more stable than that in group M,and the value of each point was higher than that of M group,especially in T1,T2 and T3.The heart rate of group D at T1(65.32±9.711),T2(66.16±9.754),T3(68.96±13.661),T4(69.24±11.882)is lower than that of group M at T1(70.47±14.632),T2(69.32±14.664),T3(71.29±14.719),T4(71.89±13.673)(P<0.05).The heart rate of group D was more unstable than that of M group,and the value of each point was lower than that of M group,especially in T1,T2,T3 and T4.The blood oxygen saturation of group M at T5(99(97.5,100)),T6(99(97,100))is lower than that of group D at T5(100(99,100))?T6(100(99,100))(P<0.05).There was 1 case bradycardia and 1 case of hypoxemia occurred in group D.There were 2 cases of hypotension and 2 cases of hypoxemia occurred in group M.The BIS and R scores in the two groups were not statistically significant,but the change region of BIS value in group D at each recording point is larger than that in M group,especially in T2,T3,T4 and T5.In group D,the arousal rate(100.0%)was higher than that in M group(92.11%),and the body mobility rate(40.0%)in group D was higher than that in group M(23.7%).In group M,the forgetting rate(94.7.0%)was higher than that in D group(68.0%),and the two groups were statistically significant(P<0.05).There were 3 cases of postoperative pain in M group.There was no statistically significant difference of satisfaction with the surgeon between the two groups.Conclusion: Midazolam or dexmedetomidine compound fentanyl used in EVL is safe and effective.The inhibition of the two drugs on circulation and respiratory system was low,and the patients had high arousal rate during operation,and postoperative pain was lower.It is worth noting that we should avoid low blood pressure and dissatisfactory analgesia in the application of midazolam compound fentanyl,and avoid bradycardia and dissatisfactory sedation in the application of dexmedetomidine compound fentanyl.The two kinds of anesthetics all make EVL more efficient,which deserve to be promoted. |
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