CAJ | 학술논문

目的：研究无痛肠镜检查术中使用丙泊酚联合不同剂量右美托咪定(Dex)的麻醉效应。方法60例择期行无痛肠镜检查的患者按使用Dex剂量的不同，分为D1组(0.25μg·kg-1)、 D2组(0.5μg·kg-1)和D3组(0.75μg·kg-1)各20例。检查前三组分别静脉泵注不同剂量Dex后，再静脉注射丙泊酚1~1.5 mg·kg-1，检查过程中Dex以0.5μg·kg-1·h-1的速率持续输注至检查完毕。观察三组患者麻醉前(T0)、给药后5 min (T1)、开始进镜时(T2)、进镜后5 min (T3)、术毕时(T4)及苏醒时(T5) MAP、HR、 SpO2的情况，记录患者丙泊酚总用量、可唤醒时间、离院时间及不良反应发生情况。结果 D1组丙泊酚总用量明显高于D2、 D3组，可唤醒时间明显长于D2、 D3组，差异均具有统计学意义(P<0.05)；三组离院时间相比无显著差异(P>0.05)。与T0时比较，给药后D1、 D2组各时点MAP均下降， D3组MAP呈现先升高(T1时增高)后降低的双相变化；与T0时比较，给药后三组各时点HR均下降，且D3组降低幅度显著大于D1、 D2组，差异有统计学意义(P<0.05)；三组各时点SpO2均无显著差异(P>0.05)。 D3组心动过缓的发生率显著高于D1、 D2组，差异具有统计学意义(P<0.05)；三组呼吸暂停、头晕、恶心呕吐的发生率相比无统计学差异(P>0.05)。结论右美托咪定联合丙泊酚用于无痛肠镜检查，给予右美托咪定负荷剂量0.5μg·kg-1后以0.5μg·kg-1·h-1速率维持，能达到满意的麻醉效果且不良反应较小，值得在临床中推广。
목적：연구무통장경검사술중사용병박분연합불동제량우미탁미정(Dex)적마취효응。방법60례택기행무통장경검사적환자안사용Dex제량적불동，분위D1조(0.25μg·kg-1)、 D2조(0.5μg·kg-1)화D3조(0.75μg·kg-1)각20례。검사전삼조분별정맥빙주불동제량Dex후，재정맥주사병박분1~1.5 mg·kg-1，검사과정중Dex이0.5μg·kg-1·h-1적속솔지속수주지검사완필。관찰삼조환자마취전(T0)、급약후5 min (T1)、개시진경시(T2)、진경후5 min (T3)、술필시(T4)급소성시(T5) MAP、HR、 SpO2적정황，기록환자병박분총용량、가환성시간、리원시간급불량반응발생정황。결과 D1조병박분총용량명현고우D2、 D3조，가환성시간명현장우D2、 D3조，차이균구유통계학의의(P<0.05)；삼조리원시간상비무현저차이(P>0.05)。여T0시비교，급약후D1、 D2조각시점MAP균하강， D3조MAP정현선승고(T1시증고)후강저적쌍상변화；여T0시비교，급약후삼조각시점HR균하강，차D3조강저폭도현저대우D1、 D2조，차이유통계학의의(P<0.05)；삼조각시점SpO2균무현저차이(P>0.05)。 D3조심동과완적발생솔현저고우D1、 D2조，차이구유통계학의의(P<0.05)；삼조호흡잠정、두훈、악심구토적발생솔상비무통계학차이(P>0.05)。결론우미탁미정연합병박분용우무통장경검사，급여우미탁미정부하제량0.5μg·kg-1후이0.5μg·kg-1·h-1속솔유지，능체도만의적마취효과차불량반응교소，치득재림상중추엄。
Objective To study the anesthetic effect of propofol combined with different doses of dexmedetomidine (Dex) on analgesic enteroscopy. Methods 60 patients scheduled to undergo analgesic enteroscopy were divided into group D1 (0.25μg·kg-1), group D2 (0.5 μg·kg-1) and group D3 (0.75 μg·kg-1) according to different doses of Dex used in patients, with 20 cases in each group. Before enteroscopy, three groups were given different doses of Dex by intravenous infusion, and then received propofol for 1~1.5 mg·kg-1. All patients was injected Dex at 0.5μg·kg-1·h-1 during the entire enteroscopy. The MAP, HR and SpO2 of patients before anesthesia (T0), 5 min after injection (T1), at the beginning of inserting enteroscope (T2), 5 min after enteroscopy (T3), after surgery (T4) and woke up from surgery (T5) were observed, the overall dosage of propofol, wake-up time, discharge time and adverse reactions were recorded. Results The overall dosage of propofol in group D1 was higher than that in group D2 and group D3, the wake-up time of group D1 was longer than that of group D2 and group D3, with statistical difference (P<0.05);the discharge time of three groups had no statistical difference (P>0.05). The MAP at different time point after injection of group D1 and group D2 decreased compared with T0, the MAP of group D3 increased first (at T1) and decreased afterwards;HR at different time point after injection of three groups decreased compared with T0, and the reduction of group D3 was greater than that of group D1 and group D2, with statistical difference (P<0.05);the SpO2 at different time point of three groups had no statistical difference (P>0.05). The incidence of bradycardia of group D3 was higher than that of group D1 and group D2, with statistical difference (P <0.05); the incidence of apnea, dizziness, nausea and vomiting of three groups had no statistical difference (P >0.05). Conclusions The application of Dex (after giving loading dose for 0.5μg·kg-1 and then inject at 0.5μg·kg-1·h-1) combined with propofol in analgesic enteroscopy can achieve satisfactory anesthetic effect, with fewer adverse reactions, which deserves promotion in clinic.