Narcotrend 监测下小剂量右美托咪定辅助丙泊酚全凭静脉麻醉在老年患者行无痛肠镜检查中的效果

Efficacy of Small Dose of Dexmedetomidine Assisting Total intravenous Anesthesia with Propo-fol under Narcotrend Monitoring in Elderly Patients Undergoing Painless Colonoscopy

【目的】探讨Narcotrend（NT）麻醉深度监测仪监测下小剂量右美托咪定辅助丙泊酚全凭静脉麻醉在老年患者行无痛肠镜检查时的麻醉安全性及临床效果。【方法】本院2012年10月至2013年3月行无痛肠镜检查的老年患者90例，随机分为右美托咪定＋丙泊酚组（DP组，45例）和安慰剂＋丙泊酚组（NP组，45例）。DP组按0．1μg／（kg · min）静脉泵注右美托咪啶，NP组静脉泵注相同容量的生理盐水做对照，丙泊酚静脉泵注维持麻醉。观察并比较两组患者术中体动、术中知晓等不良反应发生率，心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）出现异常的例数，检查总时间、可唤醒时间（从停药至能被唤醒睁眼的时间）、丙泊酚的用量。【结果】DP组和NP组比较，检查总时间较短，丙泊酚用量较少，可唤醒时间较短，且两组相比较差异有显著性（ P ＜0．05）。两组患者SpO2下降发生率虽无显著性差异，但NP组较DP组更早出现下降。【结论】老年患者在作无痛肠镜检查时小剂量右美托咪定辅助丙泊酚全凭静脉麻醉可取得较好的协同麻醉镇静效果，同时在Narcotrend监测下，可有效减少丙泊酚用量，缩短患者恢复和清醒的时间，增加麻醉的安全性和可控性。

[Objective] To explore the safety and clinical efficacy of small dose of dexmedetomidine assis‐ting total intravenous anesthesia with propofol under Narcotrend（NT） monitoring of anesthesia depth in elderly patients undergoing painless colonoscopy .[Methods] Totally 90 elderly patients undergoing painless colonos‐copy from Oct .2012 to March 2013 were randomly divided into dexmedetomidine plus propofol group （group DP ,n=45） and placebo plus propofol group（group NP ,n=45） .Group DP received dexmedetomidine pump infusion intravenously by 0 .1 μg/（kg · h） ,while group NP received the same volume of normal saline pump infusion intravenously .Intravenous propofol pump infusion was used for maintenance anesthesia .The inci‐dence of adverse reactions such as intraoperative body movement and wakefulness ,the number of abnormal heart rate（HR）,mean arterial pressure（MAP） and SpO2 ,total examination time ,recovery time（the time from drug withdrawal to recovery ） and propofol dosage were observed and compared between two groups .[Results] Compared with group NP ,total examination time was shorter ,and propofol dosage was less ,and the recovery time was shorter in group DP ,and there were significant differences（ P 〈0.05） .There was no significant difference in the declining of SpO2 between two groups ,but SpO2 in group NP decreased earlier than that in group DP .[Conclusion]Small dose dexmedetomidine assisting total intravenous anesthesia with propofol has good synergic anesthesia and sedation efficacy , and can effectively decrease propofol dosage , shorten recovery and consciousness time of patients and increase the safety and controllability of anesthesia un‐der Narcotrend monitoring .