小剂量右旋美托咪定联合芬太尼和丙泊酚对老年肠镜检查中呼吸循环的影响

目的评估小剂量右旋美托咪定（dexmedetomidine，Dex）联合芬太尼和丙泊酚对老年患者无痛肠镜检查时呼吸循环的影响。方法60名接受肠镜检查的老年患者随机分成实验组（Dex组）和对照组。首先，实验组在10min内缓慢静脉注射右旋美托咪定负荷剂量0．5μg／kg，对照组给予等量生理盐水。其次，负荷剂量推注后两组均静脉推注芬太尼1μg／kg，再缓慢推注丙泊酚，直至患者入睡，开始检查。负荷剂量推注后实验组以右旋美托咪定0．2μg·kg-1·h-1的速率维持至术毕。对照组给予等量生理盐水。术中两组按需追加丙泊酚。记录BP、HR、SpO2、ECG、RR的术前基础值（T0），诱导开始10min（T1），诱导结束（T2），术中每5min记录一次。记录两组所用丙泊酚的总量，术中心血管不良反应和呼吸抑制的发生例数。结果实验组T1较TOMAP、HR、RR和SpO2均无明显变化（P〉0．05），T2较TOMAP、HR、SpO2和RR均下降（P〈0．01o对照组T1较TOMAP、HR和SpO：均无明显变化（｜P〉0．05），T2较TOMAP、SpO2和RR均下降（P〈O．01），HR无明显变化（P〉0．05）。T2实验组MAP、SpO2、RR均高于对照组（P〈0．05o实验组的丙泊酚总用量较对照组减少（P〈0．01），术中低血压和呼吸抑制的发生率降低（P〈0．05）。结论小剂量右旋美托咪定联合芬太尼丙泊酚较单用芬太尼丙泊酚，血流动力学更稳定，呼吸抑制更轻，可安全地用于老年患者的无痛肠镜检查。

The effects of small dose of dexmedetomidine combined with fentanyl and propofol on respiration and haemodyna-mics in elderly patients undergoing colonoscopy

Objective To evaluate the effects of small dose of dexmedetomidine combined with fentanyl and propofol on respiration and haemodynamics in elderly patients undergoing colonoscopy. Methods Sixty aged patients were randomly divided into Dex group and control group. 0.5 μg/kg Dex was infused as initial loading dose followed by continuously infusing 0.2 μg .kg-1 .h-1 Dex in Dex group. The same dose of saline was infused in control group. 1 μg/kg fentanyl and propofol were infused after the initial loading dose in both groups until the patients became sleepy and the colonoscopy began. During the operations, propofol was infused when necessary. The HR, MAP, SpO：, RR of patients were recorded when they entering the operation room （T0）, 11） min （T1）, the end of induction （T2）. every 5 min during the operations. The dose of propofol and incidence of cardiovascular events and respiratory depression were recorded during colonoscopy. Results MAP, HR, SpO2, RR in Dex group had no significant change at T1 , compared with TO （P〉0.05）. MAP, HR, SpO2, RR in Dex group were decreased significant at T2, compared with TO （P〈0.01）. MAP, HR, SpOt, RR in control group had no significant change at T1, compared with TO （P〉0.05）. MAP, SpO2, RR in control group were decreased significant at T2, compared with TO （P〈0.01）, MAP, HR, SpO2, RR in Dex group were increased significant at T2, compared with control group （P〈0.05）. Dex groups required significantly less propofol compared with control group （P〈 0.01） during colonoscopies. The incidence of hypotension and clinically significant respiratory depression in Dex group was lower than that in control group （P〈0.05）. Conclusion The small dose of Dex combined with fentanyl and propofol can be used safely and effectively for elderly patients undergoing colonoscopy, which providing more stable hemodynamic and less respiratory depression.