酒石酸布托啡诺或右美托咪定分别联合丙泊酚在无痛胃镜下食管静脉曲张套扎术中的临床疗效比较

Comparison of clinical efficacy of butorphanol tartrate or dexmedetomidine combined with propofol in painless gastroscopy for esophageal varices ligation

目的观察比较了布托啡诺或右美托咪定应用于无痛胃镜下食管静脉曲张套扎术中的临床效果。方法将本院行食管静脉曲张套扎术的患者,随机分为右美托咪定联合组(A组)、布托啡诺联合组(B组)和单纯丙泊酚组(C组),每组30例肝硬化患者。在基础麻醉方法上,A组静脉泵注右美托咪定0.6μg/kg,B组缓慢注射布托啡诺10μg/kg,而C前(T_0)和给药后5 min(T_1)、15 min(T_2)及25 min(T_3)时的HR、MAP、RR和Sp(O_2),记录手术耗费时间、清醒时间和丙泊酚的总用量,并对满意度评分和不良反应进行比较。结果与T_0相比,三组患者的HR均明显下降,在同一时间点上,C组的HR最高,A组次之,B和Sp(O_2)均没有发生明显变化(P> 0.05)。C组患者手术耗费时间和清醒时间最长,使用丙泊酚的总用量最大(P <0.05),而B组患者丙泊酚的总用量最少(P <0.05),A、B组患者在术中和术后的不良反应较少。结论两种联合用药在内镜下食管静脉曲张套扎术中的临床效果均较好,但丙泊酚联合布托啡诺可降低丙泊酚的用量,值得临床推广应用。

Objective To observe the clinical effect of butorphanol or dexmedetomidine in the treatment of esophageal varices ligation under painless gastroscopy.Methods Patients who underwent esophageal variceal ligation were randomly divided into dexmedetomidine combination group(group A),butorphanol combination group(group B)and propofol group(group C),and each group has 30 patients with cirrhosis.After anesthesia,group A was intravenously injected with dexmedetomidine 0.6μg/kg,and group B was slowly injected with butorphanol 10μg/kg,and group C was intravenously injected with propofol 1.0~2.0 mg/kg.The HR,MAP,RR,and Sp(O2)were recorded before the patient′s pre-dose(T0)and 5 min(T1),15 min(T2),and 25 min(T3).And the time of operation and awake,and the total amount of propofol were also recorded.The satisfaction score and adverse reactions were compared among the groups.Results Compared with T0,the HR of the three groups decreased significantly(P).At the same time point,the HR of the C group was the highest,the A group was the second,and the B group was the lowest(P﹤0.05).There were no significant changes in RR and Sp(O2)among the three groups at different time points(P﹥0.05).Patients in group C had the longest operation time and awake time,and the total dose of propofol was the largest(P﹤0.05),while the total dose of propofol was the lowest in group B(P﹤0.05).Patients in group A and B had fewer adverse reactions during and after surgery.Conclusion The clinical effects of the two combined drugs in endoscopic esophageal variceal ligation are good,but propofol combined with butorphanol can reduce the dosage of propofol,which is worthy of clinical application.