右旋美托咪啶复合小剂量芬太尼在肥胖患者胃镜检查治疗中的作用

Safety and efficacy of dexmedetomidine combined with low dose of fentanyl for obese patients undergoing painless gastroscope

目的探讨右旋美托咪啶复合小剂量芬太尼在肥胖患者胃镜检查治疗中的临床效果及安全性。方法自愿行无痛胃镜检查和治疗患者80例,ASAⅠ~Ⅱ,随机分为右旋美托咪啶组（D组）和靶控输注丙泊酚组（P组）。入室监测血压、脉搏、氧饱和度和脑电双频指数（BIS）。D组泵注右旋美托咪啶1.5μg/kg前静脉给予芬太尼0.5μg/kg,10 min注射完毕后,P组静脉给予芬太尼0.5μg/kg,靶控输注丙泊酚血浆浓度为3.0μg/L。记录给药前（T）、给药后1、3、5、10 min,胃镜通过咽喉时,检查治疗结束时,唤醒时患者的心率、平均动脉压、呼吸频率、BIS值。记录二组出现呼吸抑制的人数,治疗出现干呕反射的人数,恶心呕吐的发生,体动例数,给药至插入胃镜时间,给药至治疗结束时长,胃镜操作结束至恢复意识时间。结果与P组相比,D组可以在稳定的血流动力学和较浅的镇静下完成胃镜治疗,呼吸抑制明显降低（P〈0.05）,干呕恶心发生也降低（P〈0.05）。结论右旋美托咪啶复合芬太尼减少肥胖患者因镇痛镇静带来的呼吸抑制,同时降低干呕恶心等不良反应的发生。

[ Objective ] A clinical study was conducted to investigate the safety and efficacy of dexmedetomidine combined with low dose of fentanyl for obese patients undergoing painless gastroscope. [ Methods ] Eighty obese patients requiring gastroscopie,belonging to ASAⅠ - Ⅱ were randomly assigned to received 1.5 μ g/kg of dexmedetomidine in ten minutes followed by 0.5 μg/kg of fentanyl or target-controlled infusion 3.0 μg/L of propofol Plasma concentration followed by 0.5 μg/kg.Mean arterial pressure,heart rate,hemoglobin oxygen saturation levels and BIS were recored at each time .the rate of retch,vomit,respiratory depression,body activity,full recovery time,operation time were recored. [ Results ] The rate of respiratory depression and retch were lower in Group D（P〈0.05）.the BIS in Group D was higher than that in Group P. [ Conclusion ] Dexmedetomidine with low dose of fentanyl for sedation of obese patients undergoing painless gastroscopy are more effective and safe than propofol with fentanyl.