瑞芬太尼联合丙泊酚或右美托咪定在内镜黏膜下肿物剥离术中应用  

Remifentanil combined with propofol or dexmedetomidine in patients undergoing endoscopic submucosal dissection

作　　者：李鑫 张瑜[2] 张静[1] LI Xin, ZHANG Yu, ZHANG Jing(Department of Anesthesia, The people＇s Hospital of Liaoning Province, Shenyang 110016, Chin)

机构地区：[1]辽宁省人民医院麻醉科,辽宁沈阳110016 [2]沈阳军区总医院麻醉科,辽宁沈阳110016

出　　处：《临床军医杂志》2018年第3期275-278,281,共5页Clinical Journal of Medical Officers

摘　　要：目的比较右美托咪定联合瑞芬太尼和丙泊酚联合瑞芬太尼这两种麻醉方案应用于内镜黏膜下肿物剥离术(ESD)的有效性、安全性和舒适性。方法选取自2016年7—12月收治的拟行ESD术的80例患者为研究对象。将所有患者随机分为右美托咪定联合瑞芬太尼组(DR组)和丙泊酚联合瑞芬太尼组(PR组),每组各40例。DR组输注右美托咪定,PR组输注丙泊酚,维持脑电双频指数(BIS)值在65~75的范围内。两组均以6μg/(kg·h)的速率持续输注瑞芬太尼。评估两组内窥镜入喉的松弛度、胃蠕动度、医师及患者的满意度等。记录两组呼吸频率(RR)、呼气末二氧化碳浓度(PETCO_2)、心率(HR)、脉搏氧饱和度(SpO_2)、平均动脉压(MAP)、术中肢体躁动情况及不良反应发生情况。结果在PR组内窥镜入喉更容易("非常好进镜",25.0%比57.5%,P<0.05),DR组的胃活动度更多的被抑制("蠕动轻微",97.5%比72.5%,P<0.05)。内镜医师对DR组的手术过程更满意(100.0%比85.0%,P<0.05);两组患者的满意度比较,差异无统计学意义(P>0.05)。PR组的MAP在标记肿瘤边缘(T_3)、黏膜下切除胃肿瘤(T_4)时明显低于DR组,HR在T_3、T_4、手术结束(T_5)时明显高于DR组,差异均有统计学意义(P<0.05)。PR组肢体躁动2例(5.0%),明显低于DR组的9例(22.5%),两组间比较,差异有统计学意义(P<0.05);PR组呼吸抑制9例(22.5%),明显高于DR组的1例(2.5%),两组间比较,差异有统计学意义(P<0.05);两组患者均未发生呼吸道梗阻、恶心呕吐及反流误吸。结论瑞芬太尼联合丙泊酚或右美托咪定均可安全、有效的应用于ESD手术。右美托咪定联合瑞芬太尼对患者呼吸抑制少,胃蠕动度更低,内镜医师更满意;而丙泊酚联合瑞芬太尼使患者进镜耐受好、体动少,但需要严密监测,以避免呼吸相关并发症的发生。Objective To compare the efficacy, safety and comfort of the two anesthesia regimens （remifentanil combined with propo- fol/dexmedetomidine） in endoscopic submucosal dissection（ ESD ）. Methods A retrospective study was performed 80 cases of pa- tients undergoing ESD from July to December of 2016. Patients were randomly divided into the dexmedetomidine combined with remifentanil（DR） group and propofol combined with remifentanil （PR）group, with 40 cases in each group. Patients in the DR group were given dexmedetomidine, the others in the PR group were given propofol, and to maintain a score of Bispectral Index in 65-75. Remifentanil was infused continuously at a rate of 6 p,g,/kg per hour in both groups. The laxity value of the endoscope into the larynx, gastric motility grading and satisfaction of the physicians and patients were assessed. The respiratory rate （ RR）, end-tidal carbon diox- ide partial pressure （ PET CO2 ）, heart rate （ HR）, pulse oxygen saturation （ SpO2 ）, mean arterial pressure （ MAP ）, intraoperative body ag- itation and adverse reactions between the two groups were recorded. Results It was much easier to advance the endoscope into the larynx in patients of PR group（ ＂very easy to advance the endoscope＂ ,25.0% versus 57. 5% ,P 〈 0. 05 ）, the gastric motility was more inhibited in patients of DR group（ ＂creeping slightly＂ ,97.5% versus 72. 5 % ,P 〈 0. 05 ）. The endoscopic physicians in the DR group had more satisfaction with the surgical procedure（ 100. 0% versus 85.0%, P 〈 0. 05 ） ;there was no statistically significant difference in satisfaction of patients between the two groups（ P 〉 0.05 ）. MAP in the PR group was significantly lower than that in the DR group at marked tumor margin（ T3 ） and submucosal excision of gastric tumor（ T4 ） ;HR in the PR group were significantly higher than that in the DR group at T3, T4 and the end of the surgery （ T5 ）, and the differences were statistically significant （ P 〈 O. 0

关 键 词：右美托咪定 丙泊酚 瑞芬太尼 胃蠕动度 黏膜下剥离术 

分 类 号：R614[医药卫生—麻醉学]