不同剂量右美托咪定对老年患者经内镜逆行胰胆管造影术异丙酚用量的影响

Effects of different doses of dexmedetomidine on the amout of propofol for endoscopic retrograde cholangiopancreatography in elderly patients

目的探讨在脑电双频指数（BIS）监测下应用不同剂量右美托咪定（DEX）对老年患者经内镜逆行胰胆管造影（ERCP）术异丙酚的用量。方法选择拟行ERCP和/或取石术的老年患者66例,年龄64~81岁,ASAⅠ~Ⅱ级,按数字表随机法分为3组。均采用气管内插管全麻,各组麻醉诱导及维持方法相同。D1、D2组右美托咪定用量分别为0.5、1.0μg/kg（稀释成20mL）,对照组生理盐水20mL,均在麻醉前静脉泵注,输注时间10 min;同时监测患者生命体征和BIS,术中调整异丙酚用量以维持BIS值在45~55。记录麻醉前（T_1）、右美托咪定输注结束时（T_2）、麻醉诱导结束时（T_3）、气管插管时（T_4）、乳头肌切开取石时（T_5）、术毕（T_6）、清醒拔管时（T7）的BIS值和生命体征,记录异丙酚用量,手术操作和拔管时间,记录术中应用血管活性药情况,记录术后镇静情况和术后谵妄等不良事件发生情况。结果与对照组比较：D_1、D_2组在T_2、T_3时点BIS值降低（P〈0.05）;D1组异丙酚用量减少、术后谵妄发生率低;D_2组异丙酚用量减少、苏醒时间延长,阿托品使用率增加（P〈0.05）。与D_1组比较,D_2组异丙酚用量减少,苏醒时间延长,阿托品使用率增加（P〈0.05）,术后镇静评分高。结论在BIS监测下,0.5、1.0μg/kg右美托咪定预注分别减少老年患者ERCP术中异丙酚用量约20%和25%;但1.0μg/kg右美托咪定可致术中心率降低、苏醒时间延长及术后过度镇静。

Objective To investigate the different doses of dexmedetomidine（DEX）on the consumption of propofol under the bispectral index（BIS）monitor for endoscopic retrograde cholangiopancreatography（ERCP）in elderly patients.Methods Sixty-six ASA physical status I or Ⅱ elderly patients,who were aged 63-81 years and underwent ERCP examination were randomly assigned into 3group（n=22each）using a random number table：0.5μg/kg DEX group（D1group）,1.0μg/kg Dex group（D_2 group）,and control group（C group）.Three groups were all general anesthesia with endotracheal intubation.0.5μg/kg（D_1 group）,1.0μg/kg（D_2 group,in normal saline 20mL）and normal saline 20mL（C group）were respectively infused over 10 min tenous a pump before anesthesia,while the patients vital signs and BIS value were monitored.Dosages of propfol were adjusted by BIS value between 45-55 value duration of surgery.At before anesthesia（T_1）,immediately after completion of DEX infusion（T_2）,immediately after induction of anesthesia（T_3）,immediately after of intubation（T_4）,while pulling the stone（T_5）,at end of surgery and when the patients were awake（T_7）,the BIS value and vital signs was recorded.Theconsumption of propofol duration of ERCP and extubation time were also recorded.The requirement of vasoactive drugs,the cases of postoperative sedation and postoperative delirium were recorded.Results Compared with C group,BIS values decreased at T_2,T_3 in D_1 group and D_2 group,amount of propofol consumed and the incidence of delirium were decreased in D_1 group,amount of propofol consumed were decreased,but the emergence time was prolonged and the requirement for atropine was increased in D_1 group（P〈0.05）.Compared with D_1 group,amount of propofol consumed were decreased,emergence time was prolonged and the requirement fou atropine was increased（P〈0.05）.Ramsay-sores were increased in D_2 group.Conclusion Pre-infusion of 0.5μg/kg DEX and 1.0μg/kg DEX are decreased amount of propofol consumed about 20% and 25%for ERCP in elderly patients.But 1.0μg/kg DEX is reduced Heart Rate,prolonged emergence time and postoperative sedation.