【摘要】 目的 大多数病人在接受胃镜时要进行镇静麻醉。广泛采用的镇静麻醉方法是同时静脉注射小剂量的咪唑安定及局部用利多卡因。然而，这种方法是否提高患者耐受性及是否增加心肺风险很少有人提及。针对这一情况，我们采用随机、双盲及安慰剂对照方法进行了一项前瞻性实验。 方法 200例在接受胃镜检查的门诊病人被分成几组分别进行下列的用药实验:(1)咪唑安定(35μg/kg)静脉给药和利多卡因喷洒(100mg)。(2)咪唑安定静脉给药及局部喷洒安慰剂代替利多卡因。(3)静脉注射安慰剂替代咪唑安定、局部喷洒利多卡因。(4)分别以安慰剂替代咪唑安定及利多卡因。 结果 与分别以安慰剂替代咪唑安定和利多卡因的第四组相比第一组耐受性提高23点(95%可信度);第二组提高15点(95%可信度);第三组提高10点(95%可信度)。 结论 小剂量咪唑安定(35μg/kg)静脉给药结合利多卡因喷洒有益于提高病人的耐受性，并且极少导致心肺参数的明显改变，这一点恰恰为清醒镇静麻醉的广泛应用提供了支持。

    【关键词】 胃镜 咪唑安定 利多卡因 耐受力 心肺参数

    Conscious sedation for gastroscopy:patient tolerance and cardiorespiratory parameters

    Zheng Guiling，Wang Dongxu，Tian Jian254Hospital，PLA，Tianjin300142.

    【Abstract】 Objective Most patients receive conscious sedation for gastroscopy.However，the benefit of the most often used combination of low-dose intravenous midazolam and topical lidocaine on patient tolerance remains poorly defined and has not been shown to outweigh cardiorespiratory risks。To respond to these issues，a randomized，double-blindplacebo-controlled prospective study was performed.Methods Two hundred outpatients undergoing diagnostic gastroscopy were assigned to receive either(1)midazolam(35μg/kg)and lidocaine spray(100mg);(2)mida-zolam and placebo lidocaine;(3)placebo midazolam and lidocaine;(4)placebo midazolam and placebo lidocaine.Re-sults Tolerance improved as compared with placebo midazolam placebo lidocaine by23points(95%confidence in-terval ......