小剂量右美托咪定复合靶控输注异丙酚在肥胖患者无痛肠镜检查中的应用

Application of small dose dexmedetomidine combined with target-controlled infusion of propofol in painless enteroscopy for patients with obesity

目的探讨肥胖患者进行无痛肠镜检查中小剂量右美托咪定(Dex)复合靶控输注(TCI)三种不同预设血浆浓度的异丙酚的麻醉效果并分析其安全性。方法选择来门诊行择期无痛肠镜检查患者120例,随机分为试验组(A组,60例)和对照组(B组,60例),A组麻醉前泵注右美托咪定0.5μg/kg、10 min完成,B组10 min完成泵注等比例的0.9%氯化钠溶液,按照TCI异丙酚预设血浆浓度的不同将A、B组随机分为A1和B1组(2μg/ml)、A2和B2组(3μg/ml)、A3和B3组(4μg/ml),选择A、B组患者在麻醉前(T1)、泵注右美托咪定或0.9%氯化钠溶液后10 min(T2)、患者意识消失后(T3)、肠镜检查开始后5 min(T4)、检查结束时(T5)5个时间点,并比较脑电双频指数(BIS)、血氧饱和度(SPO2)、平均动脉压(MAP)、呼吸频率(RR)。观察2组患者术中有无追加异丙酚、有无呛咳、呼吸抑制、低血压、低氧血症等并发症发生。评价2组患者的镇静效果(Ramesay评分)和离院评分。结果 A1组T4、T5时间点BIS、RR、MAP、SPO2值均优于B1/A2/A3组(P<0.05);A1组未发生各种并发症,A2、A3组发生呛咳、呼吸抑制、低血压、低氧血症等并发症均高于A1组(P<0.05);A1组Ramesay评分满意数、离院评分适合数均高于B1组,而A2、A3组中离院评分不适合离院的数量大于A1组(P<0.05)。结论肥胖患者进行无痛肠镜检查时,在预先泵注0.5μg/kg右美托咪定负荷剂量的前提下,TCI异丙酚2μg/ml的预设血浆浓度能够起到良好的麻醉效果,有效降低呼吸抑制等并发症的发生,提高镇静效果。

Objective To investigate the anesthesia effects and safety of small dose dexmedetomidine（ Dex）combined with target-controlled infusion（ TCI） of propofol at three different preset plasma concentrations in painless enteroscopy for patients with obesity. Methods One hundred and twenty patients who underwent painless enteroscopy in our hospital from May 2015 to August 2016 were randomly divided into trial group（ group A,n = 60） and control group（ group B,n = 60）. The patients in group A were given Dex 0. 5μg/kg by intravenous pumping,within 10 min,however,the patients in group B were given equal volume 0. 9% sodium chloride solution. According to different preset target plasma concentration of propofol,the group A and group B were redivided into group A1 and B1（ 2μg/ml）,group A2 and B2（ 3μg/ml）,group A3 and B3（ 4μg/ml）. The 5 time points were selected in group A and group B including before anaesthesia（ T1）,10 min after pumping（ T2）,loss of consciousness（ T3）,5 min after enteroscopy（ T4）,end of the operation（ T5）. Then the BIS,SPO2,MAP,RR were detected,moreover,the additional propofol,cough,respiratory repression,hypotension,hypoxia and incidence rate of complications during the operation were observed. Finally the sedative effects including Ramesay score and leaving hospital score were evaluated and compared between the two groups. Results The BIS,RR,MAP,SPO2 in group A1 at T4,T5 were superior to those in group B1,A2,A3（ P〈0. 05）. No complications were found in group A1,however,cough,respiratory repression,hypotension and hypoxia were found in group A2 and group A3. The Remasay scores and leaving hospital scores in group A1 were obviously higher than those in group B1,but leaving hospital scores in group A1 were superior to those in group A2 and group A3（ P〈0. 05）. Conclusion When obese patients receive painless enteroscopy,pumping beforehand intravenously Dex 0. 5μg/kg combined with target-controlled infusion of propofol of 2μg/ml can obtain satisfactory anaesthesia effects,which can effectively decrease incidence rates of complications and can increase sedative effects.