不同负荷剂量右美托咪啶用于内镜逆行胰胆管造影术效果比较

Comparison of Efficacies of Different Loading Doses of Dexmedetomidine in Endoscopic Retrograde Cholangiopancreatography

目的评价不同负荷剂量右美托咪啶复合异丙酚静脉全身麻醉对内镜逆行胰胆管造影（ERCP）术循环和应激反应的影响,探讨适合ERCP手术的剂量.方法选择90例择期行ERCP手术患者按随机、双盲法分为右美托咪啶低剂量负荷组（D1组）与右美托咪啶高剂量负荷组（D2组）,每组45例.D1组术前按0.5μg·kg-1静脉泵注右美托咪啶,泵注10min,D2组术前按1.0μg·kg-1静脉泵注右美托咪啶,泵注10min,然后2组均按0.6μg·kg-1·h-1静脉输注右美托咪啶50mL;2组手术开始前2min均注射异丙酚1.0mg·kg-1,然后以2～4mg·kg-1·h-1泵注异丙酚.记录给药前（T0）,进内镜即刻（T1）,手术开始后10min（T2）、20min（T3）、30min（T5）及手术结束时（T6）的MAP、HR、RR、SPO2值,记录体动!呛咳次数,SPO2≤90%或呼吸频率≤9次·min^-1的次数及苏醒时间、手术时间、异丙酚用量、芬太尼用量.于T0、T3时点取5mL静脉血测定血清肾上腺素水平.结果D2组MAP、HR在T4-T6时点均较D1组显著降低（P〈0.05）,异丙酚、芬太尼用量较D1组显著减少（P〈0.05）,T3时点肾上腺素水平较D1组显著降低（P〈0.05）.D2组呼吸抑制、心动过缓发生率均较D1组显著升高（P〈0.05）,而体动!呛咳发生率较D1组显著减少（P〈0.05）.结论右美托咪啶负荷量0.5μg·kg^-1可安全用于ERCP保留自主呼吸的静脉全身麻醉,并且能较好地控制术中的应激反应,维持血流动力学稳定.

ABSTRACT:Objective To evaluate the influences of different loading doses of dexmedetomidine (DEX)combined with propofol for general anesthesia on circulation and stress reaction in endo-scopic retrograde cholangiopancreatography(ERCP).Methods Ninety patients scheduled for ER-CP were randomly divided into two groups,with 45 patients in each group.Group D1 and group D2 were given intravenous infusion of DEX 0.5 and 1.0 μg· kg-1 before operation,respectively, pump injected 10 minutes.Then,all patients received intravenous infusion of 50 mL DEX 0.6 μg ·kg-1 .In addition,all patients were injected with propofol 1.0 mg·kg-1 at 2 minutes before op-eration,followed by intravenous infusion of propofol 4-7 mg· kg-1 .The mean arterial pressure (MAP),heart rate(HR),respiratory rate(RR)and blood oxygen saturation(SPO2 )were meas-ured before administration(T0 ),immediately after endoscope insertion(T1 ),10 minutes after be-ginning of operation(T2 ),20 minutes after beginning of operation(T3),30 minutes after begin-ning of operation(T5 ),and at the end of operation(T6 ).Furthermore,times of body movement/cough,times of SPO2 ≤ 90% or RR≤ 9 time· min-1 ,awakening time,operation time,propofol dosage,and fentanyl dosage were recorded.Moreover,5 mL venous blood was drawn at T0 and T3 to determine the serum levels of adrenaline.Results Compared with group D1 ,MAP and HR at T4-T6 ,dosages of propofol and fentanyl,adrenaline levels at T3,and incidence of movement/cough significantly decreased in group D2 (P < 0.05).However,the incidence of respiratory de-pression and bradycardia in group D2 was significantly higher than that in group D1 (P <0.05). Conclusion Intravenous infusion of dexmedetomidine with a loading dose of 0.5 μg·kg-1 can be safely used in the general anesthesia for ERCP.In addition,it can effectively control intraoperative stress reaction and maintain hemodynamic stability.