不同麻醉药物用于内镜下食管静脉曲张套扎术的临床观察  

Effects of different drugs on patients undergoing endoscopic variceal ligation

作　　者：李凯[1] 邹军[1] 赵国庆[1] 李长锋 王芳 张斌 

机构地区：[1]吉林大学中日联谊医院麻醉科,长春130033 [2]内镜中心

出　　处：《中华消化内镜杂志》2014年第9期499-502,共4页Chinese Journal of Digestive Endoscopy

基　　金：吉林省科技发展计划-社会发展项目

摘　　要：目的观察不同药物用于内镜下食管静脉曲张套扎术（EVL）的镇静镇痛效果。方法择期行EVL的60例患者随机均分成3组，分别为哌替啶组（A组）、丙泊酚组（B组）和右美托咪定组（C组）。记录患者血压、心率、脉搏血氧饱和度变化情况，镇静评分（Ramsay评分），内镜操作和麻醉时间，医生满意度，术中及术后不良反应，术后24h随访有无术中知晓和患者满意度。结果B、C组术中Ramsay评分分别为（5．2±0．3）分、（3．5±0．4）分，显著高于A组的（1．6±0．4）分（P〈0．05）。A组呛咳、躁动和高血压发生率分别为40％、40％和30％，B、C组均未发生（P〈0．05）。B、C组医生满意度分别为（9．2±0．3）分和（9．6±0．4）分，显著高于A组的（5．0±0．4）分（P〈0．05）。B、C组患者满意度分别为（9．6±0．3）分和（9．6±0．4）分，显著高于A组的（5．4±0．3）分（P〈0．05）。3组内镜操作时间无差异。麻醉时间B组为（35±4）min，C组为（36±5）min，2组明显少于A组的（44±6）min（P〈0．05）。B、C组麻醉时间、医生及患者满意度无差异，但C组心动过缓、低血压、低氧血症发生率显著低于B组（5％比40％，0比30％，0比30％，P〈0．05）。随访B、C组患者均未发生术中知晓。结论丙泊酚或右美托咪定复合芬太尼用于EVL镇静镇痛效果优于哌替啶基础麻醉，且应用右美托咪定呼吸循环较丙泊酚更稳定。Objective To study the sedative and analgesic effects of different drugs on patients under- going endoscopic variceal ligation（EVL）. Methods Sixty patients undergoing selective EVL were randomly assigned to three groups ： pethidine group （ A）, propofol-fentanyl group （ B ） and dexmedetomidine-fentanyl group（C）. Data concerning blood pressure, heart rate, peripheral oxygen saturation, Ramsay score, endo- scopic operation and anesthesia time, surgeons＇ satisfaction and adverse reactions were recorded. Follow-up was done 24 hours later to confirm the patients＇ satisfaction and incidence of intraoperative awareness. Results The Ramsay scores of group B（5. 2±0. 3） and C（3.5±0. 4） were significantly higher than group A （ 1.6 ± 0. 4 ） （ P 〈 0. 05 ）. There was no cough, body movement and high blood pressure during the EVL in group B or C, while the incidences of these symptoms in group A（40% ,40% and 30% ） were obviously higher （P 〈 0. 05）. The surgeons＇ satisfaction of group B （9. 2 ± 0. 3 ） and C （9. 6 ± 0. 4） were significantly higher than that of group A （5.0 ± 0. 4） （P 〈 0. 05 ）. The patients＇ satisfaction scores of group B （9. 6 ± 0. 3 ） and C （9. 6±0. 4） were also markedly higher than that of group A（5.4 ±0. 3） （P 〈0. 05）. There was no difference of operation time among the three groups. The anesthesia time of group A （44 ± 6） was obviously longer than those of group B（35 ±4） and C（36 ±5） （P 〈0. 05）. There was no difference in patients＇ or surgeons＇ satis- faction, or anesthesia time between group B and C. But the incidences of bradycardia （40%）, hypotension（ 30% ） and hyoxemia （30%） in group B were obviously higher than those of group C （5 %, 0, O） （ P 〈 0. 05 ）. There was no intraoperative awareness in group B or C. Conclusion Both dexmedetomidine and propofol com- bined with fentanyl are superior to pethidine for patients undergoing EVL, while dexmedetomidine provides

关 键 词：内窥镜 哌替啶 丙泊酚 右美托咪定 食管静脉曲张套扎术 

分 类 号：R614[医药卫生—麻醉学]