舒芬太尼复合下右美托咪定用于经食管超声心动图造影镇静半数有效剂量的研究

Study of the half effective dose of sufentanil combined with dexmedetomidine for sedation by contrast-enhanced transesophageal echocardiography

目的通过序贯法研究舒芬太尼复合下右美托咪定用于经食管超声心动图造影(contrast transesophageal echocardiography,cTEE)镇静半数有效剂量。方法采用前瞻性研究设计,研究对象选取于十堰市人民医院超声影像中心拟行经食管超声心动图造影检查的住院患者26例,年龄18~65岁,美国麻醉医师协会分级(American Society of Anesthesiologists,ASA)Ⅰ~Ⅱ级。第一例患者右美托咪定首负荷剂量设置为0.8μg/kg,阶梯剂量为0.1μg/kg,通过上一例患者的cTEE应激反应确定下一例患者的负荷量,当上一例患者cTEE应激反应阳性时,下一例患者的右美托咪定负荷量增加0.1μg/kg,当上一例患者cTEE应激反应为阴性时,则下一例患者的右美托咪定负荷量减少0.1μg/kg,以“cTEE应激反应阳性-cTEE应激反应阴性”为拐点,以此类推,直至出现7个拐点,试验完成。记录麻醉前、探头置入前、探头置入时、探头置入后2 min、检查结束时的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、血氧饱和度(pulse oxygen saturation,SpO_(2))及Ramsay镇静评分,记录麻醉前后左心室射血分数(left ventricular ejection fraction,LVEF)、左心室短轴缩短率(fraction shortening,FS)、左心室每搏输出量(stroke volume,SV),记录患者Valsalva动作能否配合;记录咳嗽呛咳、恶心、低血压、心动过缓等不良反应及并发症。结果舒芬太尼复合下右美托咪定用于经食管超声心动图造影镇静半数有效剂量为0.66μg/kg(95%CI:0.59~0.72),探头置入前、探头置入时、探头置入后2 min、检查结束时的HR、MAP较麻醉前低(P<0.05);探头置入时的HR、MAP较探头置入前、探头置入后2 min、检查结束时高(P<0.05),各时间点对应的SpO_(2)及麻醉前后LVEF、FS、SV变化不明显(P>0.05),所有患者麻醉抑制应激反应之后的Ramsay镇静评分(2.91±0.58)分均在理想镇静深度2~4分之间,检查过程中均能够配合Valsalva动作,无低氧饱和度、低血压、心动过缓等不良反应发生。结论通过序贯法确定舒芬太尼复合下右美托咪定用于经食管超声心动图造影镇静半数有效剂量为0.66μg/kg(95%CI:0.59~0.72)。

Objective To explore the half effective dose of sufentanil combined with dexmedetomidine for sedation by contrast-enhanced transesophageal echocardiography(cTEE)using a sequential method.Methods A prospective research design was adopted,and 26 inpatients aged 18-65 years that were scheduled to undergo cTEE at the Ultrasound Imaging Center of People's Hospital of Shiyan City and classified by American Society of Anesthesiologists(ASA)as gradeⅠ-Ⅱwere enrolled in this study.For the first patient,the first loading dose of dexmedetomidine was set to 0.8μg/kg,and the stepped dose was 0.1μg/kg.The cTEE stress response of the previous patient was used to determine the load of the next patient.When the cTEE stress response of the previous patient was positive,the next patient's load of dexmedetomidine was increased by 0.1μg/kg.When the cTEE stress response of the previous patient was negative,the load of dexmedetomidine was reduced by 0.1μg/kg in the next patient.cTEE negative stress response was taken as the inflection point,and so on,until 7 inflection points appeared,when the test was completed.Mean arterial pressure(MAP),heart rate(HR),pulse oxygen saturation(SpO_(2))and Ramsay sedation score before anesthesia,before probe placement,during probe placement,at 2 min after probe placement,and at the end of the examination were recorded.Left ventricular ejection fraction(LVEF)before and after anesthesia,left ventricular fraction shortening(FS),left ventricular stroke volume(SV)were recorded.Whether the patients could perform a Valsalva maneuver was recorded.Cough and choking,nausea,hypotension,bradycardia and other adverse reactions and complications were recorded.Results The half effective dose of sufentanil combined with dexmedetomidine for sedation by transesophageal echocardiography was 0.66μg/kg(95%CI:0.59-0.72).HR and MAP before probe placement,during probe placement,at 2 min after probe placement,and at the end of the examination were lower than those before anesthesia(P<0.05);HR and MAP during probe placement were higher than those before probe placement,at 2 min after probe placement,and at the end of the examination(P<0.05).The corresponding SpO2 at each time point and the LVEF,FS,and SV before and after anesthesia did not change significantly(P>0.05).The Ramsay sedation score(2.91±0.58)of all patients after anesthesia inhibited the stress response was between 2 and 4 points in the ideal sedation depth,and they were able to perform a Valsalva maneuver during the examination,and there was no adverse reaction,such as hypoxia,hypotension,or bradycardia.Conclusion The half effective dose of sufentanil combined with dexmedetomidine for sedation by cTEE was determined by the sequential method to be 0.66μg/kg(95%CI:0.59-0.72).