右美托咪定复合舒芬太尼与异丙酚用于肥胖患者无痛胃镜检查的临床价值

目的探讨右美托咪定复合舒芬太尼与异丙酚用于肥胖患者无痛胃镜检查的临床应用效果和安全性。方法将拟行无痛胃镜检查的136例肥胖患者随机分为观察组（以右美托咪定复合舒芬太尼和异丙酚为麻醉方案）与对照组（以舒芬太尼复合异丙酚为麻醉方案），每组各68例。观察组男37例，女31例，年龄44.6±8.5岁；对照组男39例，女29例，年龄43.2±6.8岁。比较两组麻醉效果、诱导时间、检查时间、苏醒时间、定向力恢复时间及异丙酚用量。观察两组患者麻醉诱导前（T₀）、入镜时（T₁）、镜体至会厌水平时（T₂）、术毕时（T₃）、术毕后5 min（T₄）等时间点平均动脉压、心率、呼吸频率的变化。检测两组T₀、T₄时皮质醇、去甲肾上腺素等应激指标浓度水平，记录围术期不良反应，并调查内镜医师、麻醉医师及患者满意度。结果观察组麻醉优良率为92.65%，高于对照组的72.06%（P<0.05）。观察组诱导时间、苏醒时间、定向力恢复时间短于对照组（P<0.05），异丙酚用量低于对照组（P<0.05）。对照组T₁、T₂、T₃ 时平均动脉压、心率、呼吸频率的变化程度大于观察组（P<0.05）。与T₀时比较，两组T₄时皮质醇、去甲肾上腺素水平增高，但观察组增加程度低于对照组（P<0.05）。观察组体动、呛咳、呼吸抑制、低血压的发生率低于对照组（P<0.05）。观察组的内镜医师满意度、麻醉医师满意度及患者满意度高于对照组。结论右美托咪定复合舒芬太尼与异丙酚用于肥胖患者无痛胃镜检查，麻醉效果好，患者术中生命体征稳定，不良反应少。 

Clinical effect and safety of dexmedetomidine combined with sufentanil and propofol in painless gastroscopy for obese patients

ObjectiveTo investigate the clinical effect and safety of dexmedetomidine combined with sufentanil and propofol in painless gastroscopy for obese patients.MethodsA total of 136 obese patients who were to undergo painless gastroscopy were randomly divided into group D (with dexmedetomidine combined with sufentanil and propofol as the anesthetic regimen) and group C (with sufentanil combined with propofol as the anesthetic regimen), with 68 cases each. There were 37 males and 31 females with an average age of 44.6±8.5 in observation group, 39 males and 29 females with an average age of 43.2±6.8 in control group. The anesthetic effect, induction time, examination time, waking time, directional force recovery time and propofol dosage were compared between the two groups. The changes of mean arterial pressure (MAP), heart rate (HR) and respiratory rate (RR) in two groups were observed before the induction of anesthesia (T₀), at the time of endoscopic induction (T₁), from the endoscopic body to the level of epiglottis (T₂), at the end of operation (T₃), and 5 min after operation (T₄). The stress indicators such as cortisol (Cor) and norepinephrine (NA) at T₀ and T₄ were measured. The perioperative adverse reactions were recorded. The satisfaction of endoscopists, anesthesiologists and patients were investigated.ResultsThe excellent and good rate of anesthesia in group D was higher than that in group C (92.65% vs 72.06%, P<0.05).The induction time, awakening time and directional force recovery time of group D were shorter than that of group C (P<0.05), and the dosage of propofol was lower than that of group C (P<0.05).The changes of MAP, HR and RR in group C at T₁, T₂ and T₃ were significantly greater than those in group D (P<0.05). Compared with T₀, Cor and NA levels in the two groups increased in T₄, but the degree of increase in group D was lower than that in group C (P<0.05). The incidences of body movement, cough, respiratory depression and hypotension in group D were lower than that in group C (P<0.05).The satisfaction of endoscopists, anesthesiologists and patients in group D was higher than that in group C.ConclusionFor painless gastroscopy in obese patients, the dexmedetomidine combined with sufentanil and propofol have good anesthetic effect, stable intraoperative vital signs and few adverse reactions.