右美托咪定和芬太尼复合异丙酚用于小儿胃镜检查术的麻醉效果比较

Comparision of dexmedetomidine and fentanyl combined with propofol for gastroscopy in pediatric

目的比较右美托咪定和芬太尼复合异丙酚用于小儿胃镜检查术的麻醉效果和安全性。方法将拟行无痛胃镜检查的小儿80例随机分为两组:右美托咪定组(D组,n=40例),芬太尼组(F组,n=40例)。D组静脉输注右美托咪定0.5μg/kg,输注时间为10min,复合异丙酚1mg/kg;F组静脉输注芬太尼1μg/kg,复合异丙酚1mg/kg。两组术中异丙酚每次追加量为1mg/kg。记录患儿入胃镜室时(T0)、用药5min时(T1)、用药10min时(T2)、胃镜检查开始前(T3)、胃镜通过咽喉时(T4)、胃镜退出咽喉时(T5)和退镜后5min(T6)的心率(HR)、血氧饱和度(SpO2)及平均动脉压(MAP)水平。记录异丙酚总用量、苏醒及离室时间,记录术中呛咳、严重体动(迫使检查中断)、呼吸暂停(呼吸暂停时间>10s)、低氧血症及心血管不良事件的发生情况。记录苏醒期恶心呕吐和躁动的发生情况。结果 D组在T4-T6时点HR和MAP明显低于F组(P<0.05);与T0时点比较,F组在T4-T6时点HR和MAP均明显升高(P<0.05),D组T4-T6时点的HR和MAP无明显差异(P>0.05);D组的异丙酚用量少于F组(P<0.05),镜检时间短于F组(P<0.05),两组苏醒时间无明显差异(P>0.05),D组术中呛咳、严重体动、呼吸暂停、低氧血症、心动过速及苏醒期躁动、恶心呕吐的发生率均低于F组(P<0.05)。结论与芬太尼比较,0.5μg/kg右美托咪定复合异丙酚对胃镜检查术患儿的麻醉效果好,且对呼吸循环影响小,术中术后相关的不良反应发生率低。

Objective To compare the effect of dexmedetomidine and fentanyl combined with propofol for gastroscopy in pediatric. Methods 80 ASA patients （aged 3～8 yrs, weight 18～35 kg） scheduled for gastroscopy were ramdomly divided into 2 groups （n=40）： group D （dexmedetomidine ＋ propofol） and group F （fentanyl＋propofol）. Dexmedetomidine （0.5 μg/kg） was given by infusion over 10 min followed by intravenous propofol （1 mg/kg） in group D. Fentanyl （1 μg/kg） was given by intravenous infusion for 10 min followed by propofol 1 mg / kg in group F. After the disappearance of eyelash reflex , gastroscopy was performed. The patients were kept breathing spontaneously. Additional propofol 1 mg / kg was given. The blood pressure MAP, heart rate （HR） and SpO 2 were recorded at T0 （before infusion）, T1 （infusion after 5 min）, T2 （infusion after 10 min）, T3 （beging of operation）, T4 （when gastroscope entered the throat）, T5 （when gastroscope retreat from the throat）, and T6 （5 min after operation）. The total dosage of propofol, recovery time, serious body movement, bucking, apnea, hypoxemia, adverse cardiac events and postoperative complications were also recorded. Results In group D, the HR and MAP at T4-T6 were significantly lower than group F （P〈0.05）. In group F, the HR and MAP at T4-T6 were significantly higher than the figures at T0 （P〈0.05）, and the difference was not observed in group D （P〈0.05）. The total dosage of propofol and the operation time were significantly lower in group D. The incidences of intraoperative bucking , apnea, hypoxemia, serious body movement, postoperative nausea, vomiting and agitating were significantly lower in group D （P〈0.05）. There was no difference in the recovery time between the 2 groups （P〈0.05）. Conclusion Dexmedetomidine combined with propofol has relatively little inhibitory effect on the circulatory and respiratory function in children undergoing gastroscopy.