监护麻醉技术在急诊内镜下治疗肝硬化胃底静脉曲张破裂出血患者中的应用  

Application of monitored anesthesia care technique in emergency endoscopic treatment of liver cirrhosis patients with gastric varices bleeding

作　　者：牛少宁 赵金迎 常宇飞 魏红山[3] 程灏 Niu Shaoning;Zhao Jinying;Chang Yufei;Wei Hongshan;Cheng Hao(Department of Anesthesiology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Emergency,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Gastroenterology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院麻醉科,北京100015 [2]首都医科大学附属北京地坛医院急诊科,北京100015 [3]首都医科大学附属北京地坛医院消化内科,北京100015

出　　处：《中国肝脏病杂志（电子版）》2022年第1期67-72,共6页Chinese Journal of Liver Diseases：Electronic Version

基　　金：北京市医院管理中心消化内科学科协同发展中心专项(XXZ04);首都医科大学附属北京地坛医院科研基金“育苗计划”项目(DTYM201801)。

摘　　要：目的探讨右美托咪定联合瑞芬太尼监护麻醉技术在急诊内镜下治疗肝硬化胃底静脉曲张破裂出血的效果。方法选取2019年4月至2019年10月在首都医科大学附属北京地坛医院急诊行胃镜下胃底静脉曲张破裂出血治疗的肝硬化患者60例为研究对象,采用随机数字表法分为试验组和对照组,每组30例,试验组给予右美托咪定+瑞芬太尼麻醉,对照组给予等量生理盐水,比较两组患者给药前(T0)、胃镜置入时(T1)、胃镜置入后5 min(T2)、胃镜退出时(T3)、胃镜后4 h(T4)心率(heart rate,HR)、呼吸率(respiration rate,RR)、平均动脉压(mean arterial pressure,MAP)、血氧饱和度(oxygen saturation,SpO_(2))和脑电双频指数(bispectral index,BIS)。比较两组患者不良反应发生率、患者满意度及医生满意度。结果试验组T2和T3时间点HR[T2:(77.2±14.6)次/min vs(95.7±6.8)次/min;T3:(77.2±12.5)次/min vs(87.1±7.0)次/min]和RR[T2:(13.7±2.6)次/min vs(16.2±2.8)次/min;T3:(13.2±1.8)次/min vs(15.8±2.8)次/min]显著低于对照组(P均<0.05);试验组T1、T2和T3时间点BIS均显著低于对照组(66.3±11.3 vs 95.9±1.4,64.9±11.4 vs 95.0±1.4,68.3±10.7 vs 93.8±6.3;P均<0.05),两组各时间点MAP、SPO_(2)差异无统计学意义(P均>0.05)。试验组T1、T2、T3时间点Ramsay分数均显著高于对照组[(2.43±0.50)分vs(1.13±0.35)分,(2.73±0.45)分vs(1.10±0.31)分,(2.77±0.43)分vs(1.13±0.35)分;P均<0.05]。试验组心动过速和体动发生率均显著低于对照组[15.2%(5/30)vs 50.0%(15/30),χ^(2)=7.500,P=0.013;3.3%(1/30)vs 30.3%(10/30),χ^(2)=9.017,P=0.006]。结论右美托咪定联合瑞芬太尼监护麻醉技术用于急诊内镜下治疗肝硬化胃底静脉曲张破裂出血患者能够显著降低手术操作引起的不良反应,为患者提供适当的镇静状态,保障患者安全,提高患者和医生满意度。Objective To investigate the effects of monitored anesthesia care based on dexmedetomidine combined with remifentanil in treatment of liver cirrhosis patients with gastric variceal bleeding.Method A total of 60 liver cirrhosis patients with gastric varices bleeding who underwent emergency gastroscopic treatment in Beijing Ditan Hospital,Capital Medical University from April 2019 to October 2019 were selected.The patients were divided into experimental group and control group according to random digital table method,30 cases in each group.Patients in experimental group were given dexmedetomidine+remifentanil and patients in control group were given equal amounts of normal saline.Heart rate(HR),respiration rate(RR),mean arterial pressure(MAP),oxygen saturation(SpO_(2))and bispectral index(BIS)of patients in both groups before administration(T0),during gastroscopy placement(T1),5 min after gastroscope placement(T2),after gastroscopy exit(T3)and 4 h after gastroscopy(T4)were compared.The intraoperative adverse reactions,patient satisfaction and doctor satisfaction were also compared.Results HR and RR of patients in experimental group at T2 and T3 were significantly lower than those of control group[HR:T2(77.2±14.6)time/min vs(95.7±6.8)time/min,T3(77.2±12.5)time/min vs(87.1±7.0)time/min];RR:T2(13.7±2.6)time/min vs(16.2±2.8)time/min;T3:(13.2±1.8)time/min vs(15.8±2.8)time/min;all P<0.05].BIS of patients in experimental group at T1,T2 and T3 were significantly lower than those of control group(66.3±11.3 vs 95.9±1.4,64.9±11.4 vs 95.0±1.4,68.3±10.7 vs 93.8±6.3;all P<0.05).There were no significant differences in MAP and SPO_(2)at each time points between the two groups(all P>0.05).Ramsay score of patients in experimental group at T1,T2 and T3 were significantly higher than those of control group[(2.43±0.50)points vs(1.13±0.35)points,(2.73±0.45)points vs(1.10±0.31)points,(2.77±0.43)points vs(1.13±0.35)points;all P<0.05].The incidence of tachycardia and motor body reactions of patients in experimental gro

关 键 词：监护麻醉 右美托咪定 瑞芬太尼 胃底静脉曲张破裂出血 急诊 

分 类 号：R614[医药卫生—麻醉学]