小剂量右美托咪定用于老年高血压患者无痛胃镜检查的临床观察

Low-dose dexmedetomidine on painless gastroscope in elderly patients with hypertension

目的:探讨右美托咪定注射液在老年高血压患者无痛胃镜检查中的麻醉效果及安全性。方法:择期全麻下行胃镜检查的老年高血压患者60例,根据随机数字表法分为芬太尼组(F组)和右美托咪定组(D组),每组30例。F组静脉注射芬太尼1μg/kg联合丙泊酚1.5~2.0mg/kg麻醉,D组静脉注射右美托咪定0.4μg/kg联合丙泊酚1.5~2.0mg/kg麻醉。观察并记录两组入室安静后(T0)、睫毛反射消失时(T1)、胃镜通过咽喉时(T2)、检查完成即刻(T3)、可唤醒时(T4)、检查完成后10min(T5)的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、脉搏血氧饱和度(pulse oxygen saturation,SpO2)、呼吸频率(respiratory rate,RR),记录两组丙泊酚的总用量、苏醒时间、检查中的麻醉效果和不良反应。结果:与F组比较,D组MAP变化程度较小,两组在T1时点的MAP比较,差异有显著性(P<0.05)。D组在T1、T2时点的SpO2明显高于F组(P<0.05)。与F组比较,D组丙泊酚的总用量少、苏醒时间短,差异有统计学意义(P<0.05)。D组麻醉效果优于F组;术后躁动和SpO2<90%的发生例数均明显少于F组,差异有统计学意义(P<0.05)。结论:0.4μg/kg右美托咪定用于老年高血压患者无痛胃镜检查,患者生命体征平稳,麻醉效果好,是一种安全、有效的麻醉方法。

Objective：To investigate the safety and anesthesia effect of dexmedetomidine hydrochloride injection for painless gastroscope in elderly patients with hypertension.Methods：Sixty patients with gastroscope under general anesthesia were randomly divided into fentanyl group（group F）and dexmedetomidine group（group D）,30 patients in each group.Group F was given fentanyl 1μg/kg and propofol 1.5-2.0 mg/kg for intravenous anesthesia,group D was given dexmedetomidine 0.4μg/kg and propofol 1.5-2.0 mg/kg for intravenous anesthesia.Mean arterial pressure（MAP）,heart rate（HR）,pulse oxygen saturation（SpO2）and respiratory rate（RR）were recorded at following time points：after entering the examination room（T0）,disappearance of eyelash reflex（T1）,the time when gastroscope through the throat（T2）,the end of examination（T3）,the patient could wake up time（T4）and checked in 10 min（T5）.The total amount of propofol,recovery time,the effect of anesthesia and adverse reactions during examination were recorded in the two groups.Results：The variation degree of MAP in group D was less than that in group F,there were significant difference between the two groups of MAP at T1（P〈0.05）.The SpO2 in group D at T1,T2 was significantly higher than that in group F（P〈0.05）.The total dosage of propofol in group D was less than that in group F,and the recovery time was shorter,the difference was statistically significant（P〈0.05）.The anesthesia effect in group D was better than that in group F（P〈0.05）,there were significant difference in postoperative agitation and SpO2〈90% between two groups（P〈0.05）.Conclusion：0.4μg/kg dexmedetomidine for painless gastroscope in elderly patients with hypertension provide stable vital signs,good effect of anesthesia,less adverse reactions.It is a safe anesthetic method.