右美托咪定或丙泊酚用于内镜下食管静脉曲张套扎术的比较

发布时间：2018-03-02 01:09

本文关键词： 右美托咪定丙泊酚内镜食管静脉曲张套扎术哌替啶　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：比较右美托咪定或丙泊酚复合芬太尼用于内镜下食管静脉曲张套扎术（EVL）的安全性和有效性。方法：选择择期行内镜下食管静脉曲张套扎术的患者60例，随机均分为A、B、C3组，分别为哌替啶组（A），丙泊酚组（B），右美托咪定组（C）。三组性别、年龄、体重、食管静脉曲张形态、Child-Pugh分级差异无显著性（P0.05)。所有患者术前禁食8h，禁饮6h，未使用术前药。入室前用2%利多卡因对口腔及咽喉部进行充分表面麻醉。入室后取左侧卧位，鼻导管吸氧（氧流量5L/min），监测心电图、血压、脉搏血氧饱和度。A组肌注哌替啶50mg15min后进行手术；B组静注芬太尼1.0μg/kg后，1.5mg/kg丙泊酚3min恒速诱导后进镜手术，术中以“9-7-5”恒速输注方案维持麻醉，手术结束时停药；C组静注芬太尼1.0μg/kg后，1.5μg/kg右美托咪定，10min静脉泵注后进行操作。所有手术均由同一名有丰富经验的内镜医生完成。术毕患者恢复至Ramsay评分2-3分时记为麻醉结束，转运至观察室。记录患者血压、心率、脉搏氧饱和度，Ramsay镇静评分，，内镜操作和麻醉时间以及术中、术后不良反应：呛咳、恶心、躁动、心动过缓、低血压、高血压和低氧血症。术后24小时随访，记录患者术中知晓情况及满意度（NRS，0-10），内镜医生满意度（NRS,0-10）。结果：3组患者均顺利完成手术。3组患者一般资料比较差异无统计学意义（P0.05）。B、C两组术中Ramsay评分分别为（5.2±0.3）、（3.5±0.4），显著高于A组（1.6±0.4）（P0.05）。给药后初期B组心率、血压下降显著（P0.05），进境后A组心率、血压明显升高(P0.05)，C组循环较稳定。C组术中低氧血症发生率明显低于B组（P0.05）。B、C两组均未发生呛咳、恶心、躁动或高血压，A组发生率分别为40%、60%、40%和30%，显著高于B、C两组（P0.05）。B、C两组内镜医生满意度（9.2±0.3）和（9.6±0.4）显著高于A组（5.0±0.4）（P0.05），B、C两组患者满意度（9.6±0.3）和（9.6±0.4）显著高于A组（5.4±0.3）（P0.05）。三组内镜操作时间无差异,麻醉时间B（35±4）、C(36±5)两组明显少于A组(44±6)（P0.05）。B、C两组麻醉时间、医患满意度无差异，C组心动过缓（5%）、低血压（0）、低氧血症（0）发生率显著低于B组（分别是40%、30%和30%）（P0.05）。术后随访B、C组患者无术中知晓。结论：右美托咪定或丙泊酚复合芬太尼用于EVL镇静镇痛效果均优于哌替啶基础麻醉，且应用右美托咪定时血流动力学及呼吸较丙泊酚更稳定，并可根据手术需要及时唤醒患者配合内镜操作。
[Abstract]:Aim: to compare the safety and efficacy of dexmetomidine or propofol combined with fentanyl in endoscopic esophageal variceal ligation (EVLL). Methods: sixty patients undergoing endoscopic esophageal varicose ligation were randomly divided into three groups: pethidine group, propofol group, dexmetomidine group, sex, age, body weight. There was no significant difference in Child-Pugh grade of esophageal varices (P 0.05). All patients were fasting for 8 hours before operation, and no drugs were used for 6 hours. 2% lidocaine was used to anesthetize the oral cavity and throat before entering the room. Nasal catheter oxygen inhalation (oxygen flow rate 5L / min), monitoring ECG, blood pressure, pulse oxygen saturation. Group A was intramuscularly injected pethidine for 15 minutes. Group B received intravenous fentanyl 1.0 渭 g / kg and propofol 1.5 mg / kg for 3 min. The anesthesia was maintained by "9-7-5" constant velocity infusion during the operation. At the end of the operation, fentanyl 1.0 渭 g / kg was injected intravenously in group C and 1.5 渭 g / kg dexmetidine was injected intravenously for 10 minutes. All the operations were performed by the same endoscopic doctor with rich experience. The patients recovered to Ramsay score 2-3 minutes after operation and recorded as the end of anesthesia. The patient's blood pressure, heart rate, pulse oxygen saturation and Ramsay sedation score, endoscopic operation and anaesthesia time, and postoperative adverse reactions: cough, nausea, restlessness, bradycardia, hypotension, Hypertension and hypoxemia were followed up 24 hours after operation to record the patients' intraoperative knowledge and satisfaction with NRSs 0-10, and endoscopers' satisfaction with NRSs 0-10. Results there was no significant difference in the general data of the patients in the three groups who completed the operation successfully. The intraoperative Ramsay scores of the two groups were significantly higher than those of group A (P < 5.2 卤0.3), respectively, which were significantly higher than those in group A (1.6 卤0.4), the heart rate and blood pressure in group B decreased significantly (P 0.05) at the beginning of administration, and the heart rate in group A after entering the country was significantly lower than that in group A, which was significantly higher than that in group A (P < 0.05). The incidence of hypoxemia in group C was significantly lower than that in group B (P 0.05). The incidence of restlessness or hypertension in group A was 40% and 30%, respectively, which was significantly higher than that in group B C (P 0.05 卤0.3) and in group C (P 0.05 卤0.3) and in group C (9.6 卤0.4), respectively, which was significantly higher than that in group A (5.0 卤0.4) and group B (9.6 卤0.3) and 9.6 卤0.4), respectively, and was significantly higher than that in group A (5.4 卤0.35). There was no significant difference in endoscopic operating time among the three groups. The anaesthesia time of group B was significantly less than that of group A (n = 35 卤4), and the time of anesthesia in group A was significantly less than that in group A (n = 44 卤6) P 0.05n. There was no difference in patient satisfaction. The incidence of bradycardia, hypotension and hypoxemia in group C was significantly lower than that in group B (4030% and 30%, respectively). No intraoperative knowledge was found in patients in group B and C after operation. Conclusion: the sedative and analgesic effects of dexmetomidine or propofol combined with fentanyl are better than those of pethidine basic anesthesia, and the timing hemodynamics and respiration of dexmetomide are more stable than that of propofol. According to the need of operation, the patient can wake up in time and cooperate with endoscopic operation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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