丙泊酚联合瑞芬太尼及右美托咪啶在无痛ESD术中的应用

Clinical Efficacy of Propofol with Remifentanil and Dexmedetomidine in Endoscopic Submucosal Dissection

目的：评价丙泊酚联合瑞芬太尼及右美托咪啶在内镜黏膜下剥离术（ESD）麻醉中的有效性及安全性。方法：将麻醉下行胃ESD患者50例随机分为丙泊酚维持麻醉组（A组）、丙泊酚诱导右美托咪啶复合瑞芬太尼维持麻醉组（B组）;记录给药前（T0）及给药后1min（T1）、5min（T2）、10min（T3）、20min（T4）、30min（T5）、40min（T6）时的HR、MAP、RR、SpO2,手术时间、苏醒时间、不良反应发生率、苏醒即刻下腹痛（VAS）及患者满意度。结果：所有病例均能顺利完成操作：（1）给药后A组T1-T3时点MAP、HR、RR较T0时点下降,T1-T2时点SpO2明显下降（P〈0.05）。给药后B组T1-T5时点HR较T0时点下降（P〈0.05）。（2）组间比较A组T2-T3时点MAP较B组下降（P〈0.05）,而B组患者T2-T5时点HR明显低于同时间点A组患者,B组患者在T2时点心动过缓的发生率高于A组（P〈0.05）。（3）B组患者呼吸抑制、术中体动发生率、苏醒后下腹痛低于A组（P〈0.05）。B组苏醒时间短于A组（P〈0.05）。两组手术时间、术后恶心呕吐及患者满意度差异无统计学意义（P〉0.05）。结论：丙泊酚联合瑞芬太尼及右美托咪啶用于无痛ESD,是一种安全、有效、可行的麻醉方法。

Objective：To evaluate the effect and safety of propofol with remifentanil and dexmedetomidine in endoscopic submucosal dissection（ESD）.Methods：Fifty patients undergoing anesthesia ESD were randomly divided into two groups：group A（25cases）was given maintained propofol;group B（25cases）was given induced dose of propofol,and followed with maintained dexmedetomidine and remifentanil.The following indexes were recorded：HR,MAP,RR,SpO2 at each time point before anesthesia and under operation,the time of operation and palinesthesia,the incidence of adverse reaction,VAS scores of hypogastralgia and patient satisfaction.Results：All patients were able to successfully complete the operation：（1）after administration,compared with T0 time point,HR,MAP,RR were significantly decreased at T1-T3time point,and SpO2 was significantly decreased at T1-T2time point in group A（P〈0.05）.HR was significantly decreased at T1-T5in group B（P〈0.05）.（2）Compared the two groups at the same time point,MAP was significantly decreased at T2-T3in group A（P〈0.05）,HR was significantly decreased at T2-T5in group B（P〈0.05）,and the incidence rate of beckoning bradycardia at T2 in group B was significantly high（P〈0.05）.（3）The incidence rate of respiratory inhibition,body movement,hypogastralgia and emergence time was significantly lower in group B compared with group A（P〈0.05）,and there were no significant difference between the operation time,the incidence of nausea and vomiting,and patient satisfaction in the two groups（P〉0.05）.Conclusion：The anesthetic effect of propofol with remifentanil and dexmedetomidine for patients undergoing ESD is satisfactory and safe.