右美托咪定复合丙泊酚用于双气囊小肠镜检查的临床研究

Clinical study of dexmedetomidine combined with propofol on double-balloon enteroscopy

目的探讨右美托咪定复合丙泊酚用于双气囊小肠镜检查的麻醉效果及安全性。方法40例ASA分级Ⅰ～Ⅱ级拟行双气囊小肠镜检查的患者，按随机数字表法分为右美托咪定复合丙泊酚组（复合组）和丙泊酚组，每组20例。复合组诱导前静脉泵注右美托咪定负荷量0．7μg／kg（10min），术中以0．2μg／（kg·h）持续泵注。两组均靶控输注丙泊酚，靶浓度2．5～4．0mg／L。记录患者检查前（Tn）、睫毛反射消失时（T1）、术中（T2）和检查结束时（T3）的心率、平均动脉压（MAP）、呼吸频率、脉搏血氧饱和度（SpO2）的变化，镇静评分、诱导时间、苏醒时间、丙泊酚总用量、不良反应及麻醉满意度。结果两组麻醉满意度均为100．0％。两组诱导时间、苏醒时间比较差异均无统计学意义（P〉0．05）。两组各时间点SpO2、呼吸频率比较差异均无统计学意义（P〉0．05）。复合组T1、T2心率低于本组T0和同期丙泊酚组[（65．8±7．3）、（68．6±8．2）次／min比（84．6±7．1）和（77．6±7．2）、（89．6±8．4）次／min]，差异有统计学意义（P〈0．05）；T1 MAP高于本组T0和同期丙泊酚组[（88．9±9．4）mmHg（1mmHg=0．133kPa）比（81．3±4．5）和（73．5±6．8）mmHg]，T2低于同期丙泊酚组[（80．6±6．6）mmHg比（88．5±7．6）mmHg]，差异有统计学意义（P〈0．05）。复合组镇静评分1分18例，2分2例，丙泊酚组分别为3例和17例，两组比较差异有统计学意义（P〈0．05）。复合组发生呼吸暂停2例，体动呛咳3例，丙泊酚组分别为8例和7例，两组比较差异有统计学意义（P〈0．05）。复合组丙泊酚总用量明显少于丙泊酚组[（421±76）mg比（638±89）mg]，差异有统计学意义（P〈0．05）。结论右美托咪定复合丙泊酚用于双气囊小肠镜检查可产生良好的麻醉镇痛作用，是一种安全有效的麻醉方法。

Objective To explore the efiqcacy and safety of dexmedetomidine combined with propofol on double-balloon enteroscopy. Methods Forty cases of patients ASA I - I1 grade who underwent double-balloon enteroscopy were divided into dexmedetomidine combined with propofol group （combine group） and propofol group by random digits table with 20 cases each group. Combine group was given load 0.7μg/kg （intravenous infusion for 10 rain） before induction and 0.2 μ g/ （kg＇h） continuous infusion during the surgery. All the patients were used propofol by target concentration with 2.5 - 4.0 mg/L for target-controlled infusion heart rate （HR）, mean arterial pressure （MAP）, respiratory rate （RR）, peripheral oxygen saturation （SpO2） were recorded before examination （T0）, eye lash reflex time （TI）, during the perform （T2）,the end of check （T3）,sedation score,induction time,recovery time,total propofol amount,rates of adverse reaction and satisfaition were recorded. Results The induction time,recovery time was no statistically significant difference between two groups （P 〉 0.05 ）. The RR, SpO2 was no statistically significant difference between two groups at different time points （P 〉 0.05）. The HR at T1 ,T2 in combine group was significantly lower than that at To and in propofol group same period[ （65.8 ± 7.3 ）, （68.6± 8.2） times/min vs. （84.6 ± 7.1 ） and （77.6 ± 7.2）, （89.6 ±8.4） times/min,P 〈 0.05 ]. The MAP at T1 in combine group was significantly higher than that at To and in propofol group same period [ （88.9 ~ 9.4） mm Hg （ 1 mm Hg = 0.133 kPa） vs. （81.3 ± 4.5） and （73.5 ±6.8） mm Hg,P〈 0.05],at T2 was significantly lower than that in propofol group [ （ 80.6 ±6.6） mm Hg vs. （ 88.5 ±7.6） mm Hg,P 〈 0.05 ]. Sedation score 1 score 18 cases, 2 scores 2 cases in combine group; 1 score 3 cases,2 scores 17 cases in propofol group,the difference was statistically significant （P 〈 0.05 ）. Combine group apnea two cases, moving, choking three cases, propofol group were eight cases and seven cases,the difference was statistically significant （P 〈 0.05）. The total propofol amount in combine group was significantly lower than that in propofol group [ （421 ±76） mg vs. （638 ±89） mg,P 〈 0.05 ]. Conclusion Dexmedetomidine composite target controlled infusion of propofol used for double-balloon enteroscopy can produce good narcotic analgesic which is safe and effective anesthesia.