不同剂量右美托咪定复合芬太尼用于食管静脉曲张内镜下套扎术监护性麻醉的对比研究  

Comparative study of different dosages of dexmedetomidine combined with fentanyl for monitoredanesthesia care during endoscopic variceal ligation

作　　者：李凯[1] 邹军[2] 金景鹏[3] 刘洋[3] 李龙云[1] 张斌[3] 

机构地区：[1]吉林大学中日联谊医院麻醉科,长春130033 [2]广州中山大学孙逸仙纪念医院麻醉科 [3]吉林大学中日联谊医院内镜中心

出　　处：《中华消化内镜杂志》2016年第6期388-392,共5页Chinese Journal of Digestive Endoscopy

基　　金：吉林省科技支撑计划-社会发展项目（3D514L463430）

摘　　要：目的探讨复合常规剂量芬太尼（1．0μg/kg）行食管静脉曲张内镜下套扎术监护性麻醉时右美托咪定的最佳剂量。方法60例择期行食管静脉曲张内镜下套扎术的患者，采用随机数字表法分为3组，静脉注射芬太尼1．0μg/kg后，分别恒速静脉注射负荷剂量为1．0μg/kg（D组，n=20）、1．5μg/kg（D2组，n=20）和2．0μg/kg（D，组，n=20）的右美托咪定，待改良OAAZS评分≥3分开始进镜治疗。对比各组的改良OAA／S评分变化情况、内镜操作和患者苏醒时间、患者和内镜医生满意度评分结果、不良反应发生情况。结果3组间一般状态、内镜操作时间及患者满意度评分比较差异均无统计学意义（P〉0．05）。（1）改良OAA／S评分：进镜前D3组为（4．4±0．2）分，高于D1组的（3．4±0．5）分（P〈0．05）和D2组的（3．8±0．3）分（P〈0．05），D1组与D2组差异无统计学意义（P〉0．05）；术中5vainD，组为（4．5±0．3）分，也高于D1组的（3．5±0．6）分（P〈0．05）和D2组的（3．7±0．4）分（P〈0．05），D1组与D2组差异仍无统计学意义（P〉0．05）；术毕即刻，3组间差异均无统计学意义（P〉0．05）。（2）患者苏醒时间：D3组为（6．6±1．2）min，明显长于D1组的（3．1±0．9）min（P〈0．05）和D：组的（3．8±0．8）min（P〈0．05），D，组与D2组差异无统计学意义（P〉0．05）。（3）内镜医生满意度评分：D，组为（8．0±0．8）分，明显低于D1组的（9．4±0．6）分（P〈0．05）和D3组的（9．5±0．5）分（P〈0．05），D2组与D3组差异无统计学意义（P〉0．05）。（4）不良反应发生率：3组均无心动过速、高血压和低氧血症发生，低血压发生率无组间差异（P〉0．05）；恶心、体动发生率D．组分别为30％（6／20）、15％（3／20），D2组均为5％（1／20），D3组均未发生，D，组恶心、体动发生率均明�Objective To investigate the ideal dosage of dexmedetomidine（DEX） with 1.0 μg/kg fentanyl for monitored anesthesia care （MAC）during endoscopic variceal ligation （EVL）. Methods A total of 60 patients scheduled for elective EVL were randomly divided into 3 groups （n= 20）. After fentanyl was infused intravenously at the dosage of 1.0 μg/kg, the loading dosage of DEX at 1.0 μg/kg （group D1 ）,the modified OAA/S score reaching〉3 point, EVL was carried out. The change in modified OAA/S score, the operation duration time, recovery time, satisfaction rates of patient and doctor, and complications were recorded. Results There were no significant differences in regarding of general status, operation duration time and satisfaction score of patients between the 3 groups （P 〉 0. 05 ）. Before endoscope insertion, the OAA/S score in group D3 （ 0. 4 ± 0. 2 ） was higher than that in D1 （ 3.4 ± 0. 5 ） or D2 groups （ 3.8 ± 0. 3 ） （ P 〈 0. 05） , and there was no significant difference between the scores of Dl and D2（P〉0. 05）.At the time-point of 5 rains after endoscope insertion, the OAA/S score in group D3 （4. 5± 0. 3）was significantly higher than that in DI（ 3.5±0. 6）or D2 groups（ 3.7±0. 4） （P〈0. 05 ）, there were no significant differences between D, and D2（P〉0. 05）. At the end of the procedure,there was no significant difference in OAA/S score between the 3 groups（P〉0. 05）.Compared with group D1（3.1±0. 9）min and D2（3.8±0. 8） min, the recovery time in group D3（ 6. 6± 1.2）min was significantly longer （P〈 0. 05 ）, while there was no significant difference between D1 and Dz（P〉0.05）. The satisfaction score of endoscopist in group D1 （ 8.0±0. 8） was significantly lower than that in group D2 （ 9.4± 0. 6 ） or D3 （ 9.5 ± 0. 5 ） （ P 〈 0. 05 ）, there was no significant difference between groups D2 and D3 （ P〉 0. 05 ）. No tachycardia, hypertension or hypoxemia occurred during the procedure. There was

关 键 词：内镜下静脉曲张套扎术 右美托咪定 监护性麻醉 

分 类 号：R614[医药卫生—麻醉学]