目的

观察和探讨瑞芬太尼-咪达唑仑清醒镇静镇痛在急诊医学应用的有效性、安全性和可行性。

方法

回顾性分析急诊科接受清醒镇静镇痛患者166 例，其中男性70 例，女性96 例；年龄15 ～72 岁。 ASAⅠ级142 例，Ⅱ级24 例。 禁食＞4 h 29 例，2 ～4 h 137 例。 78 例骨折和脱位的患者，24 例组织裂伤的患者，36 例脓肿患者，8 例金属异物患者。 瑞芬太尼1 μg/kg静脉负荷，然后给予0.05 μg·kg^-1·min ^-1持续泵注，直至NRS 疼痛评分为3，根据疼痛评分调整泵注速度。 咪达唑仑静脉负荷，然后0.05 mg·kg^-1min· ^-1持续泵注，直至Ramsy2 级后根据镇静评级调整泵注速度。 每一例用标准的麻醉记录单记录患者的年龄、性别、ASA级别、诊断和处理、禁食时间、不良反应、抢救措施以及离院时间。 监测记录患者的收缩压、舒张压、呼吸频率和脉搏血氧饱和度。

结果

166 例中165 例（99.4%）完成清醒镇静镇痛，9 例（5.4%）出现轻微不良反应，无一例需要气管插管，离院后1 个月随访无一例出现不良反应。 不同性别患者间不良反应发生率差异无统计学意义（P＞0.05）。发生不良反应的患者与未发生不良反应的患者年龄差异有统计学意义（P＜0.01）。 发生不良反应的患者最小年龄是19 岁，平均年龄是40 岁，而未发生不良反应患者的平均年龄是22 岁。 禁食2 ～4 h与禁食超过4 h 发生不良反应的差异无统计学意义（P＞0.05）。

结论

瑞芬太尼-咪达唑仑清醒镇静镇痛在急诊医学应用临床效果良好，是一种安全、有效、可行的方法。

Objective

To observe the efficacy，safety and feasibility of remifentanil-midazolam conscious-sedation and analgesia in emergency medicine.

Methods

A retrospective descriptive study was made on 166 patients who received remifentanil-midazolam conscious-sedation and analgesia in the Emergency Department between July 2014 and February 2015.There were 70 males and 96 females，at age of 15-72 years.According to ASA grade，there were 142 cases at gradeⅠ，24 at gradeⅡ.The fasting was for＞4 h in 29 cases and for 2-4 h in 137.There were 78 patients with reduction of fractures and common dislocations，36 with incision and drainage of abscesses，24 with laceration repair and 8 with foreign body removal.A bolus of remifentanil（1 μg/kg） and midazolam（0.02 mg/kg） was applied as loading dose，followed by infusion of remifentanil（0.05 μg/kg/min） and midazolam（0.05 mg/kg/min）.The dosage was adjusted every 3 mins according to the numeric rating scale and the Ramsay rank，respectively.Each sedation case was recorded on a standardised anaesthetic record sheet.The variables included age，sex，ASA status，presenting problem，fasting status，adverse effects，rescue manoeuvres performed and time to discharge.Patients were monitored throughout the procedure in aspects of continuous pulse oximetry，and heart rate and blood pressure.

Results

The intended procedures could be completed in 165 cases（99.4%） of 166 patients，with 9 cases（54.42%） experiencing minor adverse effects.There was no intubation required.There was no statistically significant difference between complication rates for male and female patients（P＞0.05）.A statistical difference was found in age（P=0.0024） between the patients with complications and those without complications.Patients who experienced side-effects from their treatment were older on average，with a median age of 40 years versus a median age of 22 years for those who did not experience side-effects.There was little difference in the adverse effect rate between fasted and nonfasted patients（P＞0.05）.

Conclusion

Remifentanil-midazolam conscious-sedation and analgesia is an effective，safe and feasible measure for the painful procedure in Emergency Department.