小剂量右美托咪定清醒镇静在老年人结肠镜检中的应用

Small dose of dexmedetomidine in elderly patients for conscious sedation undergoing colonoscopy

目的探讨使用小剂量右美托咪定进行清醒镇静在老年患者肠镜诊治中的可行性、有效性及安全性。方法 90例65岁以上老年患者（ASAⅠ-Ⅲ,排除相关禁忌证）随机分为3组,每组30例。A组为咪唑组,注射咪唑安定0.02 mg/kg。B组为丙泊酚组,注射咪唑安定0.02 mg/kg,丙泊酚1~1.5 mg/kg,术中以丙泊酚维持麻醉。C组为右美托咪啶组,预注咪唑安定0.02 mg/kg,缓慢泵注右美托咪定0.5~0.8μg/kg,以0.2μg/（kg·h）维持,患者术中保持OAA/S评分3~4分,若出现难以忍受的腹胀腹痛追加丙泊酚10~30 mg。记录术中以及术后生命体征,不良反应,术后患者以及操作者对过程满意度的VAS评分以及离开检查室和恢复室的时间。结果 相对于A组,B和C组都有较高的满意度和较少不良反应的发生。C组相对于B组呼吸抑制和SPO2下降的例数更少,患者保持清醒配合与检查者的合作度更高。但是C组对检查过程有记忆的比例更高,有较少数患者因为操作困难刺激强烈需要追加少量丙泊酚才能完成入镜。结论右美托咪定复合少量咪唑安定可以安全有效地用于老年人无痛肠镜诊疗。

【Objective】To investigate the feasibility and security of dexmedetomidine in elderly patients for conscious sedation undergoing colonoscopy.【Methods】Ninety elderly patients（ASAⅠ-Ⅲ,exclusion relative contraindications,age65y） undergoing colonoscopy were randomly divided into 3 groups（n=30）.In group A,midazolam 0.02 mg/kg was administered.In group B,midazolam 0.02 mg/kg as premedication was administered.intravenously.Anesthesia was induced with propofol 1~1.5 mg/kg before colonoscopy and maintained with propofol.In group C,midazolam 0.02 mg/kg was administrated intravenously and dexmedetomidine 0.5~0.8μg/kg was pumped slowly and the procedure was maintained with dexmedetomidine at 0.2μg/（kg·h）.The OAA/S score in group C was 3 to 4.However,propofol 10~30mg would be given if the patients couldn＇t stand the pain induced by operation.The perioperative and postoperative vital signs and side effects of all patients,VAS score by both patients and practitioners,and the departure time from operation room and PACU were recorded.【Results】Compared with group A,the patients in group B and C were more satisfied and the side effects were less.The cases of respiratory depression and SPO2 decreasing in group C were significantly lower than group B（P 0.05） and the patients in group C kept consciousness during the whole procedures facilitating cooperation with the practitioners.The rates of intraoperative awareness in group C were significantly higher and because of intense stimulation induced by the difficult operations,a few patients requiring additional propofol to complete colonoscopy.【Conclusion】Dexmedetomidine combining with less dosage of midazolam can be used safely and effectively in elderly patients undergoing colonoscopy.