右美托咪定两种给药方式用于无痛纤维结肠镜检查术的效果  

Effect of two administration methods about dexmedetomidine in patients with painless fibercolonscopy

作　　者：刘英[1] 张运琼 魏开明[1] 

机构地区：[1]四川省泸州市中医医院麻醉科,四川泸州646000

出　　处：《中国医药导报》2015年第25期86-89,136,共5页China Medical Herald

摘　　要：目的探讨右美托咪定两种给药方式联合丙泊酚在无痛纤维结肠镜检查术中的麻醉效果和安全性。方法选择2014年3～12月在泸州市中医医院行无痛纤维结肠镜检术的患者50例，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，性别不限，年龄19—64岁，体重42—88kg。采用随机数字表法将患者分为两组，术中持续泵注组（C组）和术前单次负荷量泵注组（S组），每组25例。C组静脉注射丙泊酚1．5～2mg／kg，并持续静脉泵注右美托咪定0．4μg／（kg·h）至手术结束，S组在10min内静脉泵注右美托眯定0．5Iμg／kg，再静脉注射丙泊酚1～1．5mg／kg。两组患者术中发生体动反应时，间断追加丙泊酚0．5—1mg／kg，维持脑电双频指数值（BIS）在55—65。记录给药前（T0）、纤维结肠镜检查前（T1）、过脾曲（T2）、过肝曲时（T3）及检查结束时（T4）的血压（BP）、心率（HR）、脉搏血氧饱和度（SPO2）和BIS。记录检查时间、苏醒时间、离院时间以及右美托咪定和丙泊酚的用量。记录术中心血管及呼吸抑制的发生情况及体动反应程度。结果与T0比较，两组在T1时收缩压（SBP）、舒张压（DBP）下降（S组：t=9．989、13．395；P=0．016、10．000。C组：t=9．126、16．384；P=0．023、0．000）；T1—T4时BIS值下降（S组：t=38．153、42．440、35．641、31．441；C组：t=39．586、38．462、37．532、34．675；均P=0．000）；C组在T1时RR下降（t=8．565，P=0.000）；与C组比较，S组在T4时BIS值升高（t=5．815，P=0.000）。其余各时点两组患者HR、SBP、DBP、SPO2和BIS差异均无统计学意义（P〉0．05）。与C组比较，S组右美托咪定用量增加（t=13．900，P=0．000），丙泊酚的用量减少（t=5．028，P=0．000），苏醒时间（t=2．577，P=0．013）及离院时间（t=2．970，P=0．005）缩短。两组患者低血压、心动过缓、呼吸抑制、血管活性药物使�Objective To evaluate the efficacy and safety of two administration methods about Dexmedetomidine in patients with painless fibercolonscopy. Methods 50 ASA physical Status Ⅰor Ⅱ patients of both sexes, aged 19-64 year, weighing 42-88 kg, scheduled for elective fibercolonscopy, were divided into two groups according to random number table continuous pump intravenous group （group C, n=25） and single load infusion in preoperative group （group S, n= 25）. In group C, Propofol 1.5-2 mg/kg was injected intravenously and Dexmedetomidine 0.4 μg/（kg·h） was infused until the end of operation. Dexmedetomidine 0.5 μg/kg was infused over 10 rain then Propofol 1-1.5 mg/kg was injected intravenously in group S. When the body movement occurred during operation in the two groups, additional Propofol 0.5- 1 mg/kg was injected intermittently to achieve a target BIS value of 55-65. The blood pressure, heart rate, pulse oxygen saturation and BIS value were recorded before administration （T0）, before operation （T1）, passing the splenic flexure （T2）, passing the hepatic flexure （T3） and the end of operation （T4）. The operation time, recovery and leaving the hospital time, the dosage of Dexmedetomidine and Propofol, the incidence of cardiovascular and respiratory depression and the degree of the body movement were also recorded. Results Compared with T0, the SBP and DBP at T1 were significantly decreased in the two groups （group S： t=9.989, 13.395; P=0.016, 0.000, group C, t=9.126, 16.384; P=0.023, 0.000）, the BIS value at T1-T4 were significantly decreased （group S： t=38.153, 42.440, 35.641, 31.441, group C： t=39.586, 38.462, 37.532, 34.675; the all P=0.000）, and the respiratory rate at T1 was decreased in group C （t=8.565, P=0.000）. There was no statistical significance at other time points of the two groups with HR, SBP, DBP, SPO2 and BIS values （P 〉 0.05）. Compared with group C, the dosage of Dexmedetomidinewas increased （t=13.900, P=0.000） and the dosage of propofol

关 键 词：右美托咪定 丙泊酚 纤维结肠镜检查术 无痛 

分 类 号：R574.62[医药卫生—消化系统]