右美托咪定复合芬太尼、丙泊酚对行内镜下逆行胰胆管造影术中老年高血压患者心血管反应的影响

Effects of Dextromethorphan Combined with Fentanyl Propofol on Cardiovascular Response in Elderly Patients with Hypertension under Endoscopic Retrograde Cholangiopancreatography

目的观察右美托咪定复合芬太尼、丙泊酚对行内镜下逆行胰胆管造影术(ERCP)中老年高血压患者心血管反应的影响。方法选取2014年5月至2015年3月于攀枝花市中西医结合医院行ERCP手术的老年高血压患者132例。按照随机数字法分为对照组和观察组。对照组64例,行静脉注射芬太尼+丙泊酚麻醉,静脉注射芬太尼1μg/kg后,再注射丙泊酚1.5 mg/kg诱导,后继续滴注丙泊酚3 mg/(kg·h);观察组68例,行静脉注射右美托咪定+芬太尼+丙泊酚麻醉,静脉注射芬太尼1μg/kg后,微泵静注右美托咪定0.3μg/kg(10 min),静脉滴注丙泊酚3 mg/(kg·h)麻醉诱导。观察记录所有患者在围治疗期的心功能指标[包括收缩压、舒张压、心率以及脉搏血氧饱和度(SpO_2)]和麻醉效果评价。结果观察组麻醉总有效率高于对照组[98.53%(67/68)比85.94%(55/64)](P<0.05)。观察组患者苏醒时间显著短于对照组[(8.6±2.3)min比(11.1±2.1)min](P<0.05)。两组患者的收缩压和舒张压在T_0~T_3时间内逐渐降低,在T_4时间点开始有所升高,且其在麻醉诱导后T_1、T_2、T_3各时间点收缩压和舒张压与T_0相比,均有显著降低(P<0.05);对照组麻醉诱导后收缩压和舒张压值降低程度高于观察组,T_1、T_2、T_3各时间点收缩压和舒张压值均显著低于观察组(P<0.05),两组在组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。两组心率、SpO_2组间、时点间、组间·时点间交互作用差异无统计学意义(P>0.05)。观察组术中躁动发生率显著低于对照组[5.88%(4/68)比21.88%(14/64)](P<0.05)。结论右美托咪定复合芬太尼、丙泊酚对行ERCP中老年高血压患者心血管反应的影响较小,安全有效,不良反应少。

Objective To investigate the effects of dexmedetomidine combined with fentanyl and propofol on cardiovascular response in elderly hypertensive patients under endoscopic retrograde cholangiopancreatography（ ERCP）. Methods A total of 132 elderly hypertensive patients who underwent ERCP were selected in Panzhihua Hospital of Integrated TCM and Western Medicine from May 2014 to Mar. 2015. According to the random number method they were divided into a control group and an observation group. The control group（ n = 64） was anesthetized by intravenous injection of fentanyl and propofol,followed by intravenous infusion of fentanyl 1 μg / kg,followed by propofol 1. 5 mg / kg and continued infusion of propofol 3 mg / kg. The observation group（ n = 68） was given intravenous injection of fentanyl 1 μg / kg,followed by dexmedetomidine 0. 3 mg / kg（ 10 min） and propofol 3 mg /（ kg·h）. The cardiac function indexes[including systolic blood pressure,diastolic blood pressure,heart rate and oxygen saturation of pulse（ SpO_2） ]and anesthetic effect during the perioperative period of two groups were recorded. Results The total effective rate of anesthesia in the observation group was higher than that of the control group[98. 53%（ 67 /68） vs 85. 94%（ 55 /64） ]（ P〈0. 05）. The recovery time of the observation group was significantly shorter than that of the control group[（ 8. 6 ± 2. 3） min vs（ 11. 1 ± 2. 1） min]（ P〈0. 05）. The systolic and diastolic blood pressure decreased gradually from T_0 to T_3 and increased at T_4,and the systolic and diastolic blood pressure at T_1,T_2,T_3 were significantly different from T0（ P〈0. 05）. The decrease of systolic and diastolic blood pressure after induction of anesthesia of the control group was higher than that of the observation group,and the systolic and diastolic blood pressure values at T_1,T_2 and T_3 were significantly lower than those of the control group（ P〈0. 05）. There was significant difference between the two groups,time points,and group·time point（ P〈0. 05）. There was no significant difference in the heart rate,SpO_2 between groups,time points,and group·time point（ P〉0. 05）. The incidence of restlessness in the observation group was significantly lower than that of the control group[5. 88%（ 4 /68） vs 21. 88%（ 14 /64） ]（ P〈0. 05）.Conclusion Dextromethorphan combined with fentany,propofol effect on cardiovascular response in elderly hypertensive patients under ERCP is little,with less adverse reaction,which is safe and effective.