右旋美托嘧啶联合雷米芬太尼在老年患者肠镜检查中的应用

目的:探讨右旋美托嘧啶联合雷米芬太尼麻醉应用于无痛结肠镜检查的安全性、有效性。方法:40例ASAⅠ～Ⅱ级患者分为右旋美托嘧啶复联合雷米芬太尼肠镜组(A组,n=20),丙泊酚联合雷米芬太尼肠镜组(B组,n=20)。雷米芬太尼负荷剂量0.5μg.kg-1,然后以0.06μg.kg-1.h-1维持。A组从静脉5 min内缓慢注入右旋美托嘧啶1μg.kg-1,然后以0.2μg.kg-1.h-1维持;B组丙泊酚负荷剂量为0.8 mg.kg-1,丙泊酚维持量6 mg.kg-1.h-1,输注至肠镜到回盲部停药。根据患者反应,单次静脉追加雷米芬太尼30μg,观察并记录患者检查前,丙泊酚给药后,右旋美托嘧啶给药后,镜检开始后1、10 min,退镜完毕后1、5 min的平均动脉血压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、呼吸频率(RR)、呼气末二氧化碳分压(Pet-CO2)和麻醉起效时间、入镜时间、苏醒时间,镇静评分、定向力恢复、离院时间以及不良反应。结果:肠镜检查中B组MAP低于A组(P<0.05),B组RR显著低于A组(P<0.01),B组PetCO2高于A组(P<0.05);检查过程中B组呼吸抑制、肢体无意识运动发生率高于A组。各组给药后、镜检中的MAP、HR、RR低于检查前(P<0.05,P<0.01),B组苏醒时间、离院时间长于A组(P<0.01),所有患者麻醉满意度为100%。结论:老年患者应用右旋美托嘧啶联合雷米芬太尼麻醉实施无痛肠镜检查是安全可行的,但应注意右旋美托嘧啶初始注药速度,并加强监测,尽可能避免心动过缓和血压的波动。

Clinical evaluation of the application of dexmedetomidine plus remifentanil in senile patients undergoing colonoscopy

OBJECTIVE To investigate the security,validity and side effects of infused dexmedetomidine plus remifentanil on senile patients with painless colonoscopy examination.METHODS Forty senile patients(ASA Ⅰ-Ⅱ)were randomly divided into 2 groups.Both groups patients were intravenously infuse with remifentanil 0.5 μg·kg-1 followed by an infusion of 0.06 μg·kg-1·h-1 In group A,patients received 1 μg·kg-1 dexmedetomidine over 5 min followed by an infusion of 0.2 μg·kg-1·h-1.Group B received propofol 0.8 mg·kg-1 followed by an infusion 6 mg·kg-1·h-1.Stoping infusion when colonoscopy got to jejunoileal blind end.According to the patients’ reaction,remifentanil 30 μg was given by intravenously infusion.The assessment included measurements of mean artery pressure(MAP),heart rate(HP),oxygen saturation(Sp02),respiratory rate(RR),end-tidal carbon dioxide partial pressure(PetCO2),quality of sedation/analgesia,and an evaluation of the onset time,recovery time,Ramsay score,orientation recovery,discharge times,and adverse reactions.RESULTS The MAP of the group B was at lower level than group A(P<0.05),RR of the group B at obvious lower level than group A(P<0.01),PetCO2 of the group B at higher level than group A(P<0.05).Compared with the group A,the group B had more body movements and respiratory depression.The orientation recovery and discharge times of the group B were longer than group A.CONCLUSION The use of dexmedetomidine plus remifentanil on senil patients for painless colonoscopy has good therapeutic effect.It is a save,effective and limited by distressing side effects,bradycardia and hypotension.