中国医药
中國醫藥
중국의약
China Medicine
2015年
9期
1386-1389
,共4页
瑞芬太尼%右美托咪定%经内镜逆行性胰胆管造影术%老年患者
瑞芬太尼%右美託咪定%經內鏡逆行性胰膽管造影術%老年患者
서분태니%우미탁미정%경내경역행성이담관조영술%노년환자
Remifentanil%Dexmedetomidine%Endoscopic retrograde cholangiopancreatography%Elderly patients
目的 探讨瑞芬太尼联合右美托咪定在老年患者无痛经内镜逆行性胰胆管造影术(ERCP)中镇痛效果及安全性.方法 选取江苏省泰州市人民医院行ERCP治疗的患者65例,将患者完全随机分为瑞芬太尼复合右美托咪定组(RY组,32例)和地西泮复合哌替啶组(D组,33例).记录诱导前(To)、诱导后(T1)、插镜(T2)、插镜后10 min(T3)、退镜(T4)、术毕(T5)各时点的平均动脉压(MAP)、心率、呼吸和脉搏血氧饱和度(SpO2),T3时点的改良警觉/镇静评分(OAA/S),观察术中及术后的不良反应,同时记录手术时间和术后满意度评分.结果 T1～T55个时点RY组患者的MAP、心率和呼吸的水平均明显低予D组[MAP:(96±14) mmHg(1 mmHg =0.133 mPa)比(114±18)mmHg、(97±12) mmHg比(110±14)mmHg、(92±11) mmHg比(111±15) mmHg、(95 ±11)mmHg比(111±16) mmHg、(95±10) mmHg比(107±13) mmHg;心率:(61±11)次/min比(78±18)次/min、(71±12)次/min比(92±18)次/min、(67±8)次/min比(85±9)次/min、(65±7)次/min比(84±13)次/min、(70±8)次/min比(80±9)次/min;乎吸:(12.4±2.2)次/min比(17.9±3.6)次/min、(13.6±1.8)次/min比(19.8±3.3)次/min、(11.9±2.2)次/min比(19.5±3.4)次/min、(14.1±2.0)次/min比(19.4±2.9)次/min、(14.9±2.4)次/min比(20.5±3.1)次/min,均P＜0.05],SpO2差异无统计学意义(P＞0.05).RY组体动、术后恶心呕吐发生率明显低于D组[(0.0％(2/32)比12.1％ (4/33)、0.0％ (0/32)比12.1％ (4/33),P＜0.05],RY组术中OAA/S评分与术后满意度评分相较于D组有明显的改善[(3.3±0.7)分比(4.4±0.5)分、(96±6)分比(87±9)分](P＜0.05).结论 瑞芬太尼联合右美托咪定用于老年患者无痛ERCP能够更好地维持患者血流动力学相对稳定,安全可行.
目的 探討瑞芬太尼聯閤右美託咪定在老年患者無痛經內鏡逆行性胰膽管造影術(ERCP)中鎮痛效果及安全性.方法 選取江囌省泰州市人民醫院行ERCP治療的患者65例,將患者完全隨機分為瑞芬太尼複閤右美託咪定組(RY組,32例)和地西泮複閤哌替啶組(D組,33例).記錄誘導前(To)、誘導後(T1)、插鏡(T2)、插鏡後10 min(T3)、退鏡(T4)、術畢(T5)各時點的平均動脈壓(MAP)、心率、呼吸和脈搏血氧飽和度(SpO2),T3時點的改良警覺/鎮靜評分(OAA/S),觀察術中及術後的不良反應,同時記錄手術時間和術後滿意度評分.結果 T1～T55箇時點RY組患者的MAP、心率和呼吸的水平均明顯低予D組[MAP:(96±14) mmHg(1 mmHg =0.133 mPa)比(114±18)mmHg、(97±12) mmHg比(110±14)mmHg、(92±11) mmHg比(111±15) mmHg、(95 ±11)mmHg比(111±16) mmHg、(95±10) mmHg比(107±13) mmHg;心率:(61±11)次/min比(78±18)次/min、(71±12)次/min比(92±18)次/min、(67±8)次/min比(85±9)次/min、(65±7)次/min比(84±13)次/min、(70±8)次/min比(80±9)次/min;乎吸:(12.4±2.2)次/min比(17.9±3.6)次/min、(13.6±1.8)次/min比(19.8±3.3)次/min、(11.9±2.2)次/min比(19.5±3.4)次/min、(14.1±2.0)次/min比(19.4±2.9)次/min、(14.9±2.4)次/min比(20.5±3.1)次/min,均P＜0.05],SpO2差異無統計學意義(P＞0.05).RY組體動、術後噁心嘔吐髮生率明顯低于D組[(0.0％(2/32)比12.1％ (4/33)、0.0％ (0/32)比12.1％ (4/33),P＜0.05],RY組術中OAA/S評分與術後滿意度評分相較于D組有明顯的改善[(3.3±0.7)分比(4.4±0.5)分、(96±6)分比(87±9)分](P＜0.05).結論 瑞芬太尼聯閤右美託咪定用于老年患者無痛ERCP能夠更好地維持患者血流動力學相對穩定,安全可行.
목적 탐토서분태니연합우미탁미정재노년환자무통경내경역행성이담관조영술(ERCP)중진통효과급안전성.방법 선취강소성태주시인민의원행ERCP치료적환자65례,장환자완전수궤분위서분태니복합우미탁미정조(RY조,32례)화지서반복합고체정조(D조,33례).기록유도전(To)、유도후(T1)、삽경(T2)、삽경후10 min(T3)、퇴경(T4)、술필(T5)각시점적평균동맥압(MAP)、심솔、호흡화맥박혈양포화도(SpO2),T3시점적개량경각/진정평분(OAA/S),관찰술중급술후적불량반응,동시기록수술시간화술후만의도평분.결과 T1～T55개시점RY조환자적MAP、심솔화호흡적수평균명현저여D조[MAP:(96±14) mmHg(1 mmHg =0.133 mPa)비(114±18)mmHg、(97±12) mmHg비(110±14)mmHg、(92±11) mmHg비(111±15) mmHg、(95 ±11)mmHg비(111±16) mmHg、(95±10) mmHg비(107±13) mmHg;심솔:(61±11)차/min비(78±18)차/min、(71±12)차/min비(92±18)차/min、(67±8)차/min비(85±9)차/min、(65±7)차/min비(84±13)차/min、(70±8)차/min비(80±9)차/min;호흡:(12.4±2.2)차/min비(17.9±3.6)차/min、(13.6±1.8)차/min비(19.8±3.3)차/min、(11.9±2.2)차/min비(19.5±3.4)차/min、(14.1±2.0)차/min비(19.4±2.9)차/min、(14.9±2.4)차/min비(20.5±3.1)차/min,균P＜0.05],SpO2차이무통계학의의(P＞0.05).RY조체동、술후악심구토발생솔명현저우D조[(0.0％(2/32)비12.1％ (4/33)、0.0％ (0/32)비12.1％ (4/33),P＜0.05],RY조술중OAA/S평분여술후만의도평분상교우D조유명현적개선[(3.3±0.7)분비(4.4±0.5)분、(96±6)분비(87±9)분](P＜0.05).결론 서분태니연합우미탁미정용우노년환자무통ERCP능구경호지유지환자혈류동역학상대은정,안전가행.
Objective To explore the effect and safety of remifentanil combined with dexmedetomidine during anesthesia of painless endoscopic retrograde cholangiopancreatography (ERCP) in the elderly patients.Methods Totally 65 elderly patients undergoing painless ERCP were randomly divided into remifentanil combined with dexmedetomidine group (32 cases) and diazepam combined with dolantin group (33 cases).The heart rate (HR),mean arterial pressure (MAP),respire rate (RR),pulse oxygen saturation (SPO2) before (T0) and after induction (T1),during endoscopy (T2),10 rain after endoscopy (T3),at withdrawal (T4) and at the end of the operation (T5) were recorded; the observer's assessment of alertness/sedation (OAA/S) scale was assessed at T3 time point scores; the adverse reactions during and after operation were observed; the duration of operation and anesthesia,and the patients' satisfaction rate were recorded.Results Compared with those in group D,the MAP,the HR and the RR in RY group were lower from T1 to Ts [MAP:(96 ± 14) mmHg vs (114 ± 18) mmHg,(97 ± 12) mmHg vs (110±14) mmHg,(92±11) mmHg vs (111 ±15) mmHg,(95±11) mmHg vs (111 ±16) mmHg,(95 ± 10) mmHg vs (107 ± 13) mmHg; HR:(61 ± 11) times/min vs (78 ± 18) times/min,(71 ± 12) times/min vs (92 ± 18) times/min,(67 ±8) times/min vs (85 ±9) times/min,(65 ±7) times/min vs (84 ± 13) times/min,(70 ± 8) times/min vs (80 ± 9) times/min; RR:(12.4 ± 2.2) times/min vs (17.9 ± 3.6) times/min,(13.6 ± 1.8) times/min vs (19.8 ±3.3) times/min,(11.9 ±2.2) times/min vs (19.5 ±3.4) times/min,(14.1 ± 2.0) times/min vs (19.4 ± 2.9) times/min,(14.9 ± 2.4) times/min vs (20.5 ± 3.1) times/min] (P ＜ 0.05) ; the SPO2 showed no significantly differences between the two groups (P ＞ 0.05).The incidences of movement,postoperative nausea and vomiting in RY group were significantly lower than those in D group [0.0％ (0/32) vs 12.1％ (4/33),0.0％ (0/32) vs 12.1％ (4/33),P＜0.05].The OAA/S score was significantly lower and the patients' satisfaction score was significantly higher in RY group than those in D group [(3.3 ± 0.7) scores vs (4.4 ± 0.5) scores,(96 ± 6) scores vs (87 ± 9) scores] (P ＜ 0.05).Conclusion Remifentanil combined with dexmedetomidine in elderly patients with painless ERCP can maintain the hemodynamics with good safety.
