静脉预注去氧肾上腺素联合持续泵注对无痛胃肠镜检查患者血流动力学影响的随机对照研究  

Hemodynamic effects of prophylactic intravenous injection combined with infusion of phenylephrine in patients undergoing painless gastrointestinal endoscopy:a randomized controlled trial

作　　者：孙浩睿 薛富善 刘缚鲲[1] 孙秀静[2] 魏威[1] 朱欣艳 SUN Hao-rui;XUE Fu-shan;LIU Fu-kun(Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China.)

机构地区：[1]首都医科大学附属北京友谊医院麻醉科,北京100050 [2]首都医科大学附属北京友谊医院消化内科,北京100050

出　　处：《临床和实验医学杂志》2020年第8期841-846,共6页Journal of Clinical and Experimental Medicine

基　　金：国家科技部国家重点研发计划项目(编号:2017Yfc1700601)。

摘　　要：目的 探讨无痛胃肠镜检查前预防性静脉注射去氧肾上腺素联合持续泵注对检查过程中患者血流动力学的影响。方法 采用前瞻性随机对照研究方法,选取2019年12月10~31日在首都医科大学附属北京友谊医院接受无痛胃肠镜检查的患者72例,利用SPSS的随机数生成器将患者随机分为去氧肾上腺素组(P组)和对照组(C组),每组各36例。P组患者在麻醉诱导给药后,立即缓慢静脉注射去氧肾上腺素50μg,同时开始静脉持续泵注去氧肾上腺素,起始剂量为30μg/min,检查过程中酌情增减泵注速度,以维持平均动脉压(MAP)波动于基础值20%以内,检查结束时停止泵注;C组患者常规给药。比较两组患者检查前、诱导给药后即刻,检查开始3 min、5 min、10 min、15 min、20 min及检查结束时的血流动力学参数(包括收缩压、舒张压、MAP和心率)、脉搏血氧饱和度、检查时间、苏醒时间、麻醉药物及血管活性药等用量和不良反应。结果 因操作方式改变,P组剔除1例。与C组(n=36)相比,P组(n=35)患者在诱导给药后,低血压的发生率较低(2. 9%vs. 36. 1%),差异具有统计学意义(P <0. 001);P组患者的MAP在诱导给药后即刻[(92±13) mmHg vs.(82±13) mmHg,P=0. 030],检查开始3 min[(87±12) mmHg vs.(77±11) mmHg,P=0. 006]、5 min[(84±11) mm Hg vs.(77±9) mm Hg,P=0. 002]、10 min[(89±8) mm Hg vs.(77±9) mm Hg,P <0. 001]、15 min[(90±9) mm Hg vs.(77±9) mm Hg,P=0. 001]、20 min[(88±8) mm Hg vs.(81±10) mm Hg,P=0. 001]、检查结束[(89±9) mm Hg vs.(84±12) mm Hg,P=0. 001]较高,但P组心动过缓(心率<50次/min)的发生率也较高(14. 3%vs. 0),差异具有统计学意义(P=0. 019);C组患者的麻黄碱用量高于P组[0(0,6) mg vs. 0(0,0) mg],差异具有统计学意义(P=0. 004)。但两组患者的脉搏血氧饱和度、胃肠镜检查时间[(20. 9±5. 8) min vs.(21. 3±6. 1) min,P=0. 752]、苏醒时间[0(0,0) min vs. 0(0,0) min,P=0. 921]、麻醉药及阿托品[0(0,0) mg vs. 0(0,0) mg,Objective To investigate the hemodynamic effects of prophylactic intravenous(IV)injection combined with infusion of phenylephrine in patients undergoing painless gastrointestinal endoscopy.Methods We performed a prospective randomize controlled study in 72 patients undergoing painless gastrointestinal endoscopy from December 10th to December 31th in Beijing Friendship Hospital,Capital Medical University.With random numbers generated by SPSS,the patients were randomly assigned into the phenylephrine group(group P,n=36)and the control group(group C,n=36).Patients in group P were slowly administered with phenylephrine(50μg,IV injection)immediately after anesthesia induction.Meanwhile,Phenylephrine was continuous infused at an initial speed of 30μg/min,then the speed was adjusted to maintain the mean arterial pressure(MAP)within 20%of baseline until the end of the procedure.The group C was only given the regular anesthetics.We compared the hemodynamic parameters including systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR)and pulse oximetry before anesthesia,immediately after induction,3 min,5 min,10 min,15min after insertion of the endoscope.Procedure time,recovery time,doses of anesthetics and vasoactive medications and adverse events were also compared.Results In group P,one participate was excluded due to the alteration of the procedure.The incidence rate of hypotension in group P(n=35)was significantly lower than that in group C(n=36)[1(2.9%)vs.13(36.1%),P<0.001].MAP at each time point after anesthesia induction were significantly higher in group P,including Ti[(92±13)mmHg vs.(82±13)mmHg,P=0.030],T 3[(87±12)mmHg vs.(77±11)mmHg,P=0.006],T 5[(84±11)mmHg vs.(77±9)mmHg,P=0.002],T 10[(89±8)mmHg vs.(77±9)mmHg,P<0.001],T 15[(90±9)mmHg vs.(77±9)mmHg,P=0.001],T 20[(88±8)mmHg vs.(81±10)mmHg,P=0.001]and Te[(89±9)mmHg vs.(84±12)mmHg,P=0.001].The incidence rate of bradycardia(HR<50 beat/min)was also higher in group P[5(14.3%)vs.0(0%),P=0.019].The use of Ephedr

关 键 词：无痛胃肠镜 去氧肾上腺素 静脉预注 持续泵注 血流动力学 

分 类 号：R57[医药卫生—消化系统]