右美托咪定用于经内镜逆行胰胆管造影术的临床观察  

Clinical observation of dexmedetomidine in endoscopic retrograde cholangio-pancreatography surgery

作　　者：李桂芹[1] 刘纪泽[2] 刁玉刚[1] 孙莹杰[1] 赵石磊[1] 

机构地区：[1]沈阳军区总医院麻醉科,沈阳110016 [2]武警辽宁省总队医院麻醉科,沈阳110034

出　　处：《实用药物与临床》2013年第9期790-792,共3页Practical Pharmacy and Clinical Remedies

摘　　要：目的观察右美托咪定（DEX）用于经内镜逆行胰胆管造影（ERCP）术监测麻醉中的有效性及安全性。方法选择急诊ERCP术患者120例,随机双盲分为2组：瑞芬太尼组（R组,60例）,DEX组（D组,60例）。R组入睡后瑞芬太尼0.04μg/（kg·min）恒速泵入,D组入睡后DEX 0.24μg/（kg·h）恒速泵入,两组患者均泵注丙泊酚4~6 mg/（kg·h）。分别记录患者麻醉诱导前（T0）、入睡后手术开始前（T1）、内镜置入后（T2）、十二指肠球部切开时（T3）、手术结束时（T4）、术后15 min（T5）时患者SBP、DBP、HR、RR、SpO2、BIS值;观察患者呼吸抑制（〈8 bpm）、低氧血症（〈93%）、呛咳躁动、恶心呕吐及清醒后伤口疼痛不适等并发症。结果两组在T0时各基础值组间比较差异无统计学意义（P〉0.05）。在T1与T0时,R组和D组SBP、DBP、HR明显降低,组内比较差异有统计学意义（P〈0.05）,组间比较差异无统计学意义（P〉0.05）;在T2~T4时,R组和D组的SBP、DBP、HR明显降低,与T0时比较差异有统计学意义（P〈0.05）,R组的SBP、DBP、HR下降比D组显著（P〈0.05）。两组患者丙泊酚用量比较差异无统计学意义（P〉0.05）。R组术中呼吸抑制及低氧血症发生率较D组高（P〈0.05）。R组术后患者自述不适感明显较D组高（P〈0.05）。结论 DEX用于ERCP术可维持患者稳定的循环状态,减少血流动力学波动,很少需要应用血管活性药;无明显呼吸抑制,可维持良好的氧和状态;呛咳躁动、恶心呕吐等并发症少。Objective To observe the advantage of dexmedetomidine（DEX） in patients undergoing ERCP.Methods 120 selective ERCP surgery patients were randomly divided into remifentanil groups（group R,n=60） and DEX group（group D,n=60）.In group R,remifentanil was used at a rate of 0.04 μg /（kg·min）,while patients in group D received continuous intravenous injection of DEX at a rate of 0.24 μg /（kg·h） after being induced.All patients received continuous injection of propofol at a rate of 4 ~ 6 mg /（kg·h）.Systolic blood pressure（SBP）,diastole blood pressure（DBP）,heart rate（HR）,pulse oxygen saturation（SpO2） and bispectral index（BIS） were determined before anesthesia（T0）,before operation（T1）,after endoscope inserted（T2）,duodenal incision（T3）,operation finished（T4）,15min after operation（T5）.Respiratory inhibitory,hypoxemia,cough and agitation,nausea and vomiting,and consciousness pain were observed.Results There was no significant difference in the baseline values of hemodynamic at T0in two groups（P0.05）.SBP,DBP and HR at T1in two groups were significantly lower than those at T0（P 0.05）.SBP,DBP and HR at T2~ T4decreased in two groups,but decreased significantly in group R（P0.05）.The dose of propofol in two groups had no significant different（P0.05）.In group R,the incidence of respiratory inhibitory and hypoxemia was higher than those in group D（P0.05）.The patients in group D were more comfortable than those in group R（P0.05）.Conclusion DEX during ERCP can maintain circulatory stable,reduce hemodynamic change and vasoactive drugs,without significant respiratory inhibitory,keep good oxygen saturation,with lowrate of the complication of cough,agitation,nausea and vomiting.

关 键 词：右美托咪定 内镜逆行胰胆管造影 监测麻醉 血流动力学 并发症 

分 类 号：R614[医药卫生—麻醉学]