麻醉深度指数监测下右美托咪定复合丙泊酚在无痛肠镜检查中的临床应用

Effects of dexmedetomidine combined with low dose of propofol on Vital Signs and Anaesthetic Depth in patients undergoing painless intestinal endoscopy

目的探讨麻醉深度指数(NT)监测下右美托咪定复合小剂量丙泊酚在无痛肠镜检查中对患者生命体征的影响以及安全性评估。方法选择无痛肠镜患者70例随机分成右美托咪定组(D组)和对照组(C组),各35例,入室开放上肢静脉,吸氧,监测血压、心率、血氧饱和度和麻醉深度指数(NTI)。D组静脉缓慢泵注右美托咪定0. 3μg/kg(泵注时间> 10 min),然后注射丙泊酚1. 0 mg/kg;C组单独静脉注射丙泊酚2. 0 mg/kg。检查中如有明显影响检查操作的体动反应,则追加丙泊酚0. 3~0. 5 mg/kg,并观察丙泊酚用量大小与呼吸和循环抑制等不良反应的关系。在确保病人无明显体动反应的前提下通过适当增加或减少丙泊酚的用量将两组麻醉深度指数(NTI)均维持在40~70。结果丙泊酚总用药量D组明显低于C组(P <0. 05);呼吸抑制例数和严重体动发生例数D组明显低于C组(P <0. 05);麻醉深度指数(NTI) D组明显高于C组(P <0. 01);循环抑制例数两组无明显差异(P> 0. 05)。结论在无痛肠镜检查中右美托咪定复合小剂量丙泊酚同单独使用丙泊酚相比具有更好的安全性,能提供更佳的术中镇静效果且大大降低丙泊酚用量。

Objective A clinical study was conducted to investigate the effects of dexmedetomidine( DEX) combined with low dose of propofol on vital signs and anaesthetic depth in patients undergoing painless intestinal endoscopy. Methods Ninety patients with ASA 1-2 requiring painless intestinal endoscopy were randomized to received DEX 0. 3 ug/kg( group D n = 35) followed by propofol 1. 0 mg/kg or propofol 2. 0 mg/kg( group C n = 45). According to the body activity and operation time,whether to add propofol 0. 3 ~ 0. 5 mg/kg or not. Full recovery time,operation time,the consumed dose of propofol,mean arterial pressure( MAP),heart rate( HR),hemoglobin oxygen saturation levels( SPO2) and NTI were recorded. Results The trend of SPO2 and the consumed dose of propof in group D were decreased to lower than that in group C( P < 0. 05);The rate of the body activity in group D was lower than that in group C( P < 0. 05);The NTI in group C was lower than that in group D( P < 0. 05);The HR and MAP were similar in both groups.Conclusion There were more efficacy and safe for DEX combined with low dose of propofol for sedation of patients undergoing painless intestinal endoscopy.