右美托咪定与咪达唑仑在经内镜逆行胰胆管造影术中的应用比较

Comparison of dexmedetomidine and midazolam for conscious sedation in ERCP

目的观察比较右美托咪定与咪达唑仑在经内镜逆行胰胆管造影术（ERCP）中对患者血流动力学及术后并发症的影响。方法选取择期行ERCP的患者60例,随机分为2组,即右美托咪定组（D组）和咪达唑仑组（M组）,每组30例。D组于10 min内给予1μg/kg负荷剂量的右美托咪定,随后以0.5μg/（kg·h）速度泵注,使拉姆齐镇静评分（Ramsay Sedation Scale,RSS）维持于3～4分。M组静脉注射0.04 mg/kg咪达唑仑,然后逐次追加0.5 mg,使RSS评分维持于3～4分。观察并比较两组患者注药前（T1）、注药后（T2）、手术开始5min（T3）、10 min（T4）、15 min（T5）及入恢复室后（T6）等各时点的生命体征（HR、M AP）及不良反应发生情况。结果 D组T3、T4、T5、T6各时点的HR明显低于T1,且明显低于M组（P〈0.05）;M组T3、T4、T5各时点的M AP明显低于T1,且明显低于D组（P〈0.05）;在手术过程中,M组患者呛咳发生率为83.3%,躁动发生率为50%,而D组分别为20%和3%,两组比较差异有统计学意义（P〈0.05）;D组需要丙泊酚辅助的例数略少于M组,但差异无统计学意义（P〉0.05）。结论相对于咪达唑仑,右美托咪定是ERCP清醒镇静时的更好选择。

Objective To compare the differences between dexmedetomidine and midazolam in ERCP by observing the changes of hemodynamics and the incidences of complications.Methods 60 patients who required ERCP were randomly divided into two equal groups：dexmedetomidine group（group D,n =30） and midazolam group（group M,n =30）.All patients received fentanyl 1 μg/kg at the beginning of ERCP.Group D received dexmedetomidine at a loading dose of 1 μg/kg for 10 min,then they were injected continuously by 0.5 μg/（kg·h） until Ramsay Sedation Scale（RSS） score reached 3 ～4.Group M received midazolam 0.04 mg/kg and additional 0.5 mg until RSS reached3 ～4.HR and MAP at pre-loading（T1）,post4oading（T2）,5 min of ERCP（T3）,10 min of ERCP（T4）,15 min of ERCP（T5）,and the time when reached the recovery room（T6） and complications in procedures were recorded.Results HR of group D was lower at T3,T4,T5,T6（P 0.05）,there were significant differences between the two groups（P 0.05）.MAP of group M was lower at T3,T4,T5（P 0.05）,there were significant differences between the two groups（P 0.05）.During the procedure,the incidences of gagging（83.3%） and restlessness（50%） of group M was higher than those of group D（20%and 3%respectively）（P 0.05）.The number of cases required propofol in group D was slightly less than that of group M,but there was no significant difference between the two groups（P 0.05）.Conclusion Dexmedetomidine is a better choice for conscious sedation in ERCP than midazolam.