小剂量右美托咪定在无痛胃肠镜检查中的应用:前瞻性随机对照研究

Effects of Low Dose of Dexmedetomidine on Painless Gastroscopy and Colonoscopy: a Prospective Randomized Controlled Study

目的探讨右美托咪定联合丙泊酚和舒芬太尼用于无痛胃肠镜检查的麻醉效果。方法 2016年1~3月选择ASAⅠ~Ⅱ级择期行无痛胃肠镜检查120例,随机分为2组(右美托咪定组和对照组),每组60例。右美托咪定组术前给予右美托咪定0.3μg/kg,由微量注射泵10 min泵完,泵注完成后静脉注射舒芬太尼0.1μg/kg,静脉缓慢推注丙泊酚1.5mg/kg,待病人睫毛反射消失后,手术开始。对照组术前给予等体积生理盐水,其余同右美托咪定组。2组病人术中静脉泵注丙泊酚,根据情况随时调整泵注速度,先进行胃镜检查,然后进行结肠镜检查,待结肠镜通过回盲瓣时停止丙泊酚的输入。记录术中应用丙泊酚总量,术中镇静镇痛效果,术中低血压、低血氧、体动,术后恶心呕吐、头晕、嗜睡等不良反应发生情况,术后腹痛情况,术后苏醒时间,离院时间。结果右美托咪定组丙泊酚用量明显少于对照组[(237.0±81.7)mg vs.(287.0±99.4)mg,t=3.010,P=0.003],苏醒时间[(4.5±2.1)min vs.(7.8±2.3)min,t=-8.207,P=0.000]、离院时间[(37.1±11.1)min vs.(42.2±11.3)min,t=-2.494,P=0.014]均明显短于对照组;右美托咪定组术中镇静镇痛效果优于对照组(Z=-5.266,P=0.000),术中低血氧、低血压、体动的发生率显著低于对照组[16.7%(10/60)vs.31.7%(19/60),χ~2=3.683,P=0.055;0.7%(4/60)vs.33.3%(20/60),χ~2=13.333,P=0.000;15.0%(9/60)vs.35.0%(21/60),χ~2=6.400,P=0.011],2组术后恶心呕吐、头晕等发生率无明显差异[13.3%(8/60)vs.15.0%(9/60),χ~2=0.069,P=0.793;15.0%(9/60)vs.13.3%(8/60),χ~2=0.069,P=0.793]。右美托咪定组术后腹痛评分中位数明显低于对照组[1(0,1)分vs.3(2,4)分,Z=-5.684,P=0.000]。结论小剂量0.3μg/kg右美托咪定可安全应用于无痛胃肠镜检查,能明显减少丙泊酚的用量,降低不良反应的发生,缓解术后腹痛。

Objective To observe the anesthesia effects of dexmedetomidine combined with propofol and sufentanil in painless gastroscopy and colonoscopy. Methods From January to March 2016,120 patients with ASA Ⅰ- Ⅱ undergoing elective painless gastroscopy and colonoscopy were randomly divided into 2 groups： dexmedetomidine group and control group. Each group consisted of 60 patients. In the dexmedetomidine group,dexmedetomidine of 0. 3 μg / kg was given intravenously by micro-pump within10 minutes preoperatively. After that,sufentanil of 0. 1 μg / kg was injected intravenously,and propofol of 1. 5 mg / kg was given. When eyelash reflexes disappeared, the operation began. While in the control group, normal saline of the same volume was given intravenously by micro-pump within 10 minutes instead of dexmedetomidine before operation. In both groups,propofol was continuously infused according to the patients＇ condition. The total volume of propofol and effect of sedation and analgesia was recorded. The side effects such as hypoxemia,hypotension,body movement,severe sinus bradycardia,nausea and vomiting,dizzy and drowsiness,were recorded. The degree of postoperative abdominal pain,recovery time and discharge time were recorded. Results The required propofol in the dexmedetomidine group was significantly less than that in the control group [（ 237. 0 ± 81. 7） mg vs.（ 287. 0 ± 99. 4）mg,t = 3. 010,P = 0. 003]. The time of recovery and discharge in the dexmedetomidine group was shorter than that in the control group [（ 4. 5 ± 2. 1） min vs.（ 7. 8 ± 2. 3） min,t =- 8. 207,P = 0. 000;（ 37. 1 ± 11. 1） min vs.（ 42. 2 ± 11. 3） min,t =- 2. 494,P = 0. 014]. The anesthesia effect was better in the dexmedetomidine group than that in the control group（ Z =- 5. 266,P = 0. 000）.The rates of hypoxemia,hypotension,and body movement were lower in the dexmedetomidine group than that in the control group[16. 7%（ 10 /60） vs. 31. 7%（ 19 /60）,χ~2= 3. 683,P = 0. 055; 0. 7%（ 4 /60） vs. 33. 3%（ 20 /60）,χ~2= 13. 333,P = 0. 000;15. 0%（ 9 /60） vs. 35. 0%（ 21 /60）,χ~2= 6. 400,P = 0. 011]. There was no significant difference in rates of nausea and vomiting and dizzy between the two groups [13. 3%（ 8 /60） vs. 15. 0%（ 9 /60）,χ~2= 0. 069,P = 0. 793; 15. 0%（ 9 /60） vs. 13. 3%（ 8 /60）,χ~2= 0. 069,P = 0. 793]. The median scores of postoperative abdominal pain were less in the dexmedetomidine group than that in the control group [1（ 0,1） points vs. 3（ 2,4） points,Z =- 5. 684,P = 0. 000]. Conclusions Low dose of dexmedetomidine（ 0. 3 μg/kg） could be used safely in painless gastroscopy and colonoscopy,and can reduce the amount of propofol. It can also decrease postoperative adverse effects and relieve patents＇ postoperative abdominal pain.