预注甲氧明对无痛胃肠镜检查血流动力学影响的随机对照研究  

Cardiovascular effects of prophylactic intravenous methoxamine on patients undergoing painless gastrointestinal endoscopy: a randomized controlled trial

作　　者：孙浩睿 刘缚鲲[1] 孙秀静[2] 魏威[1] 朱欣艳 SUN Hao-rui;LIU Fu-kun;SUN Xiu-jing(Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院麻醉科,北京100050 [2]首都医科大学附属北京友谊医院消化内科,北京100050

出　　处：《临床和实验医学杂志》2020年第5期452-456,共5页Journal of Clinical and Experimental Medicine

基　　金：国家科技部国家重点研发计划项目(编号:2017Yfc1700601).

摘　　要：目的研究无痛胃肠镜检查前预防性静脉注射甲氧明对检查过程中血流动力学的影响。方法在此项前瞻性研究中,2019年12月1日至12月31日在首都医科大学附属北京友谊医院纳入拟接受无痛胃肠镜检查的患者64例,按照SPSS生成的随机数,随机分为甲氧明组和对照组,每组各32例。甲氧明组患者在麻醉诱导给药后立即注射盐酸甲氧明1~2 mg,对照组患者注射等量生理盐水。比较两组患者检查前、诱导给药后即刻、检查开始3 min、5 min、10min、15 min以及检查结束时的血压、心率、脉搏血氧饱和度、检查时间、苏醒时间、麻醉及血管活性药等用量和不良事件。结果与对照组相比,甲氧明组患者在诱导给药后即刻(95±11 mm Hg vs.84±11 mm Hg,P<0.001)以及检查开始3 min(84±14 mm Hg vs.78±9 mm Hg,P=0.026)、5 min(83±12 mm Hg vs.75±9 mm Hg,P=0.019)时的平均动脉压更高,差异具有统计学意义;但甲氧明组患者的心动过缓(心率<50次/分)的发生率更高(18.8%vs.0,P=0.032),差异具有统计学意义。两组的脉搏血氧饱和度、检查时间、苏醒时间、麻醉药物、血管活性药物用量等比较,差异无统计学意义(P>0.05)。结论无痛胃肠镜检查前预注甲氧明有助于维持诱导期血流动力学稳定,但需密切监测心动过缓或必要时静注阿托品处理。Objective To evaluate the cardiovascular effects of prophylactic intravenous methoxamine on patients undergoing painless gastrointestinal endoscopy.Methods In this prospective trial,sixty four patients scheduled for gastrointestinal endoscopy were enrolled between December 1 st to December 31 th in Beijing Friendship Hospital,Capital University.With random numbers generated by SPSS,all patients were randomly divided into the methoxamine group(n=32)and the control group(n=32).The methoxamine group was given methoxamine 1~2 mg immediately after anesthesia induction,while the control group was only given the same amount of normal saline.We compared the blood pressure,heart rate(HR)and pulse oximetry before anesthesia(T0),immediately after induction(Ti),3 min(T3),5 min(T5),10 min(T10),15 min(T15)after insertion of the endoscope,and at the end of the procedure(Te).Procedure time,recovery time,doses of anesthetics and vasoactive medications and adverse events were also compared.Results In the methoxamine group,MAP at Ti(95±11 mm Hg vs.84±11 mm Hg,P<0.001),T3(84±14 mm Hg vs.78±9.mm Hg,P=0.026),T5(83±12 mm Hg vs.75±9 mm Hg,P=0.019)were significantly higher than that of the control group.However,the incidence of bradycardia(HR<50 beat per minute)was significantly higher than that of the control group(18.8%vs.0,P=0.032).There were no significant differences in pulse oximetry,procedure time,recovery time,doses of anesthetics and vasoactive medications between the two groups(P>0.05).Conclusion Prophylactic intravenous methoxamine can help stabilize circulation during the anesthesia induction for gastrointestinal endoscopy,but bradycardia should also be monitored or treated with intravenous atropine if necessary.

关 键 词：无痛胃肠镜检查 甲氧明 血流动力学 心动过缓 

分 类 号：R57[医药卫生—消化系统]