右美托咪定复合地佐辛不同镇静深度在ERCP术的应用

Application of dexmedetomidine combined with dezocine for different sedative depth in ERCP surgery

目的观察右美托咪定复合地佐辛应用于内镜逆行胰胆管造影(ERCP)术不同镇静深度的麻醉效果。方法 60例行ERCP术患者,均给予右美托咪定复合地佐辛麻醉,采用脑电意识监测仪(Narcotrend)监测术中镇静深度指数(NT),按NT值不同分成三组,A组NT值65~79,B组NT值57~64,C组NT值47~56,每组20例。观察记录术中、术后三组不良反应发生情况。结果 60例ERCP术患者有20例术中或术后出现不良反应,其中A组出现3例心动过速、4例呛咳体动、3例术中知晓,不良反应发生率为50%;C组出现2例低血压、3例心动过缓、3例呼吸抑制,不良反应发生率为40%;B组出现1例心动过缓、1例呛咳体动,不良反应发生率为10%;B组不良反应发生率低于A组及C组,差异均具有统计学意义(χ~2=7.619、4.800,P<0.05)。经对症处理后均顺利完成手术。结论在ERCP术中使用Narcotrend监测右美托咪定复合地佐辛的镇静深度适宜范围在57~64,不良反应发生率低。

Objective To observe the anesthesia effect of dexmedetomidine combined with dezocine for different sedative depth in endoscopic retrograde cholangiopancreatography （ERCP） surgery. Methods A total of 60 patients with ERCP surgery all received dexmedetomidine combined with dezocine for anesthesia, and they were divided by different intraoperative Narcotrend index （NT） value monitored by electroencephalogram consciousness monitor （Narcotrend） into group A with NT value as 65-79, group B with NT value as 57-64, and group C with NT value as 47-56, with 20 cases in each group. Occurrence of adverse reactions in intraoperation and postoperation were observed and recorded in three groups. Results Among 60 ERCP surgery patients, there were 20 cases with adverse reactions in intraoperation Or postoperation. Group A had 3 tachycardia cases, 4 bucking body movement cases and 3 intraoperative awareness cases, with incidence of adverse reactions as 50%, group C had 2 hypotension cases, 3 bradycardia cases and 3 respiratory depression cases, with incidence of adverse reactions as 40%, and group B had 1 bradycardia case and 1 bucking body movement casel with incidence of adverse reactions as 10%. Group B had lower incidence of adverse reactions than group A and group C, and their difference had statistical significance （X2=7.619, 4.800, P〈0.05）. The surgeries were all successfully completed after symptomatic treatment. Conclusion Sedation depth suitable range of dexmedetomidine combined with dezocine is 57~64 in ERCP surgery monitored by Narcotrend, and the incidence of adverse reactions is low.