右美托咪定在内镜逆行胰胆管造影术中的镇静作用

Application of Dexmedetomidine for Endoscopic Retrograde Cholangiopancreatography

目的：观察右美托咪定用于内镜逆行胰胆管造影术（ERCP）时的镇静作用。方法：选择行ERCP患者60例,采用随机数字表法分为舒芬太尼联合右美托咪定组（D组）和舒芬太尼联合丙泊酚组（P组）,各30例。D组给予静脉注射舒芬太尼0.1μg/kg,10min内静脉泵注右美托咪定0.5μg/kg负荷量,术中以0.5μg/（kg·h）维持;P组给予静脉注射舒芬太尼0.1μg/kg,缓慢静脉注射丙泊酚1.2 mg/kg,遇有体动,追加0.3-0.5 mg/kg。记录两组患者入室后（T0）、给药后（T1）、进镜时（T2）、术中（T3）以及苏醒时（T4）的平均动脉压（MAP）和心率（HR）,并在各时点对患者进行Ramsay评分以判定镇静程度。结果：D组T1时点的MAP较P组更高,差异有统计学意义（P〈0-05）;两组患者其他各时点的MAP、HR比较差异均无统计学意义（P〉0-05）。D组在T1、T2、T3时点的Ramsay评分与P组比较差异有统计学意义（P〈0-05）。结论：右美托咪定用于ERCP检查,镇静、镇痛效果满意,患者无呼吸抑制,血流动力学平稳。

OBJECTIVE： To observe the sedative effect of dexmedetomidine on endoscopic retrograde cholangiopancreatography （ERCP）. METHODS： In total of 60 cases of ERCP were randomly divided into Group D and Group P, 30 cases in each group. Patients in Group D were given intravenous sufentanil injection 0.1 μg/kg, and dexmedetomidine injection 0.5μg/kg within 10 minutes, and 0.5 μg/（kg. h） for maintenance in operation. Patients in Group P received intravenous sufentanil injection 0.1μg/kg, and slow propofol injection 1.2 mg/kg, and additional 0.3-0.5 mg/kg in case of body movement. The mean arterial pressure （MAP） and heart rate （HR） in 2 groups were recorded after entering the operating room （T0） and administration （T1）, using endoscopy （T2）, during surgery （T3） and waking （T4）. Ramsay was scored at different time points to determine the level of sedation. RESULTS： The MAP in group D was higher than group P at T1, with significant difference （P〈0-05） ; there were no significant differences in the MAP and HR in 2 groups at other time points （P〉0-05）. There was significant difference in the Ramsay score between group D and group P at , T2 and T3 （P〈0-05）. CONCLUSIONS： Dexmedetomidine has good sedation and analgesia effect on the ECRP. Patients are without respiratory depression and hemodynamic is steady.