右美托咪啶复合靶控输注丙泊酚用于无痛胃镜检查中的临床观察

Application of dexmedetomidine combined with target-controlled infusion with propofol for painless gastrointestinal endoscope

目的探讨右美托咪啶复合靶控输注(TCI)丙泊酚用于无痛胃镜检查的有效性及安全性。方法选择本院行无痛胃镜检查患者120例,按美国麻醉师协会(ASA)Ⅰ～Ⅱ级;年龄41～70岁,体质量50～75 kg。随机分为观察组和对照组,各60例。对照组患者开始以效应室靶浓度为4～5μg/mL TCI丙泊酚,逐渐增加至6～7μg/mL,当患者睫毛反射消失时减至4～5μg/mL;观察组在TCI丙泊酚前缓慢静脉推注(超过5 min)右美托咪啶0.4μg/kg。记录术前(T0)、睫毛反射消失时(T1)、插镜过咽喉(T2)、插镜达十二指肠(T3)、和退镜完毕时(T4)的平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SPO2)值;记录丙泊酚的总用量、诱导时间、唤醒时间和定向力恢复时间;并观察患者术中及术后并发症的情况。结果观察组T1、T2、T3时间的HR较T0时明显减慢,差别有统计学意义(P<0.05);对照组T1、T2、T3时的MAP、SPO2均较T0时显著降低,差别有统计学意义(P<0.05),组间比较显示,T1、T2时对照组的MAP、SPO2明显低于观察组,T1、T2时对照组的HR明显高于观察组,差别有统计学意义(P<0.05);观察组的诱导时间、唤醒时间及定向力恢复时间明显比对照组缩短,丙泊酚总用量比对照组减少,差别均有统计学意义(P<0.05)。观察组的术中呼吸抑制、体动反应及术后并发症发生率明显低于对照组,差别有统计学意义(P<0.05)。结论右美托咪啶0.4μg/kg复合TCI丙泊酚应用于无痛胃镜检查安全有效。

Objective To evaluate the safety and validity of dexmedtomidine combined with target - controlled infusion（TCI） with propofol in painless gastrointestinal endoscope. Methods A total of 120 patients who were undergoing painless gastrointestinal endoscope were randomly divided into observation group and control group, sixty cases in each group. The initial target plasma concentration in the control group was set at 4 - 5μg/mL, then increased to 6 - 7μg/mL, but it was decreased to 4- 5μg/mL when eyelash reflex vanished. Patients in the observation group received dexrnedetomidine 0.4μg/kg before TCI with propofol. Mean arterial pressure（MAP）, heart rate （HR） and pulse oxygen saturation（SPO2） of preoperative（T0）, elelash reflex vanishing（T1 ）, introducing gastroscope into pharynx and larynx（T2）, introducing gastroscope into duodenal（T3） and the end of operation（T4） were recorded. The propofol consumption, induction time, waking time, and orientation recovery time were recorded. The rates of patient＇ body motion and respiratory depressin and postoperative uterine contraction pain also were observed. Results HR at TI, T2, T3 was significantly lower than that at TO in the observation group （P 〈 0.05）. MAP and SPOe at T1, T2, T3 were significantly lower than those at To in the control group （P 〈 0.05）. MAP and SPO2 at TI, T2 in the control group were significantly lower than those in observation group. HR at T1, T2 in the control group were significantly higher than that in the observation group （ P 〈 0.05 ）. The propofol consumption, induction time, awake time and orientation recovery time in the observation groupwere significantly less than those in the control group （ P 〈 0. 0 5 ） . The rates of patients＇ body motion, respiratory depression and in the observation group were significantly less than those in the control group （P 〈 0.05）. Conclusion The application of 0.4μg/kg dexmedetomi- dine combining TCI with propofol in painless gastrointestinal endoscope.