纳布啡复合右美托咪定用于成人胃镜联合结肠镜检查术的麻醉效果研究

Anesthetic efficacy of nalbuphine combined with dexmedetomidine on gastroscopy combined with colonoscopy in adult patients

目的评价纳布啡复合右美托咪定用于成人胃镜联合结肠镜检查术的麻醉效果。方法选取2018年11月至2019年5月赤峰市医院行镇静/麻醉胃镜联合结肠镜检查术患者160例,采用数字表法随机分为4组,纳布啡复合右美托咪定组(N+D组)、纳布啡组(N组)、右美托咪定组(D)和对照组(C组),每组40例。麻醉诱导前10 min内N+D组和D组静脉泵注右美托咪定0.5μg/kg,麻醉诱导时N+D组和N组静脉注射纳布啡0.1 mg/kg,C组静脉注射舒芬太尼0.1μg/kg。记录麻醉起效时间、检查时间、苏醒时间、恢复时间和依托咪酯/丙泊酚(etomidate/propofol,E/P)用量;记录术后苏醒时(T1)、离开麻醉后恢复室时(T2)视觉模拟评分(visual analogue score,VAS)和Ramsay镇静评分;记录术中呼吸抑制、心动过缓、低血压、体动反应情况和术后24 h内恶心呕吐、腹痛、腹胀等不良反应发生情况。结果与C组和N组比较,N+D组麻醉起效时间、苏醒时间、恢复时间、E/P用量减少,体动反应发生率降低(P<0.05);D组在T1、T2时VAS升高(P<0.05),心动过缓、低血压、体动反应发生率升高(P<0.05)。与C组比较,N+D组和N组在T2时VAS降低(P<0.05),呼吸抑制、恶心呕吐、腹痛、腹胀发生率降低(P<0.05)。结论纳布啡0.1 mg/kg复合右美托咪定0.5μg/kg用于成人胃镜联合结肠镜检查术的麻醉效果显著,镇痛、镇静水平适宜,且相关不良反应明显降低。

Objective To explore anesthetic effect of nalbuphine combined with dexmedetomidine on gastroscopy and colonoscopy in adult patients.Methods A total of 160 cases of adult patients with gastroscopy and colonoscopy under sedation/anesthesia were randomly divided into four groups by digital table method,nalbuphine combined with dexmedetomidine group(group N+D),nalbuphine group(group N),dexmedetomidine group(group D)and control group(group C),40 cases in each group.Group N+D and group D were injected with dexmedetomidine 0.5μg/kg within 10 min before anesthesia induction,nalbuphine 0.1 mg/kg was injected intravenously in group N+D and group N,and sulfentanyl 0.1μg/kg was injected intravenously in group C at anesthesia induction.The onset time of anesthesia,examination time,recovery time and the dosage of etomidate/propofol(E/P)were recorded;visual analogue score(VAS)and Ramsay sedation score were recorded at postoperative recovery(T1)and leaving postanesthesia care unit(T2).The incidences of respiratory depression,bradycardia,hypotension and body motions during endoscopy,nausea and vomiting,abdominal pain,and abdominal distension within 24 h after endoscopy were recorded.Results Compared with group C and group N,the onset time of anesthesia,recovery time,recovery time,the dosage of E/P and the incidence of body motions were significantly decreased in group N+D(P<0.05).VAS scores at T1 and T2,and the incidences of bradycardia,hypotension,and body motions were significantly increased in group D(P<0.05).VAS scores at T2(P<0.05),and the incidences of respiratory depression,nausea and vomiting,abdominal pain and abdominal distension in group N+D and group N were lower than those in group C(P<0.05).Conclusions The anesthetic effect of nalbuphine 0.1 mg/kg combined with dexmedetomidine 0.5μg/kg used in adult patients undergoing gastroscopy and colonoscopy is significant,the analgesia and sedation level are suitable,and the adverse reactions are obviously reduced.