小剂量右美托咪定在酗酒患者无痛胃肠镜检查中的应用

Clinical study on the value of low⁃dose dexmetomidine in painless gastroenteroscopy in patients with alco⁃holism

目的评估小剂量右美托咪定(dexmedetomidine,DEX)在行无痛胃肠镜检查的酗酒患者中的临床价值。方法选取2018年7月至2020年6月在徐州医科大学附属医院行无痛胃肠镜检查的154例符合纳入标准的酗酒患者。通过随机数表法将患者分为右美托咪定+丙泊酚组(观察组)和安慰剂+丙泊酚组(对照组),每组77例,观察组患者给予右美托咪定0.3μg/kg,在麻醉前10 min通过微量注射泵泵注,随后予以静脉注射丙泊酚1.5 mg/kg;对照组同样方法泵注等量的0.9%氯化钠,丙泊酚注射方法同观察组。术中两组患者脑电双频谱指数(bispectral index,BIS)均维持在50~60。记录患者的平均脉搏血氧饱和度(SpO2)、平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、呼气末二氧化碳分压(PETCO2)、丙泊酚用量、诱导时间、检查时间、苏醒时间、出院时间、术中体动反应率、内镜医师满意度、患者满意度、不良反应等指标。结果观察组平均SpO2、内镜医师满意度明显高于对照组(P<0.05),而丙泊酚用量、诱导时间、苏醒时间、出院时间、体动反应发生率明显低于对照组(P<0.05),两组在检查时间、患者满意度方面差异无统计学意义(P>0.05)。结论小剂量右美托咪啶在酗酒患者的无痛胃肠镜检查中安全、有效,可改善镇静效果,降低不良事件的发生。

Objective To evaluate the clinical value of low⁃dose dexmedetomidine(DEX)in alcoholic patients undergoing painless gastrointestinal endoscopy.Methods A total of 154 alcoholism who underwent painless gastroenteroscopy in the Affiliated Hospital of Xuzhou Medical University from July 2018 to June 2020 who met the inclusion criteria were selected.All patients were randomly divided into dexmedetomidine+propofol group(trial group)and placebo+propofol group(control group)with 77 patients in each group.Patients in the trial group were given dexmedetomidine with 0.3μg/kg,injected through micro⁃infusion pump 10 min before anesthesia,and then given intravenous propofol with 1.5 mg/kg.The patients in the control group were given the same amount of 0.9%sodium chloride,and the injection method of propofol was the same as that in the trial group.During the operation,the bispectral index(BIS)of the two groups was maintained between 50 to 60.The mean pulse oxygen saturation(SpO2),mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR),end⁃expiratory carbon dioxide partial pressure(PETCO2),propofol dosage,induction time,examination time,recovery time,discharge time,incidence of body movement,the satisfaction of endoscopic physicians,the satisfaction of patients and adverse reac⁃tions were recorded.Results The mean SpO2 and the satisfaction of endoscopic physicians in the trial group were significantly higher than those in the control group,while the dosage of propofol,induction time,awakening time,discharge time and the incidence of physical reaction in the trial group were significantly lower than those in the control group(P<0.05).There was no significant difference in examination time and patient satisfaction between the two groups.Discussion Low⁃dose dexmetomidine is safe and effective in painless gastroenteroscopy in patients with alcoholism,which can improve the sedative effect and reduce the occurrence of adverse events.