体重指数对右美托咪定复合瑞芬太尼用于结肠镜检查的影响

发布时间：2018-06-02 11:47

  本文选题：结肠镜检查 + 右美托咪定　； 参考：《河北医科大学》2014年硕士论文

【摘要】：目的：研究不同体重指数对右美托咪定（DEX）复合瑞芬太尼用于无痛结肠镜检查的影响。 方法：应用序贯法测定右美托咪定复合瑞芬太尼用于不同体重指数患者行结肠镜检查时的半数有效剂量（ED50）。选择ASAⅠ或Ⅱ级接受无痛结肠镜检查的患者55例，年龄40～64岁，无胃肠道等腹部手术史。将患者依体重指数分为Ⅰ组（体重指数为≥24）、Ⅱ组（体重指数18.5～24）、Ⅲ组（体重指数≤18.5）。全部患者在接受检查前常规行肠道准备，入室后摆好体位，常规面罩吸氧5L/min，监测心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、呼吸频率（RR）、脑电双频指数（BIS）等指标。开放上肢静脉，各组均首先给予DEX缓慢静注2min，每组第一例患者的初始剂量均为0.3ug/kg，之后给予瑞芬太尼负荷量1ug/kg,微量泵泵入2min，继而改为维持量0.1ug/kg/min持续泵入，2min后开始操作，检查结束时停止输注瑞芬太尼。 根据序贯法，DEX按等比1.2倍的阶梯法进行调整，每组以上一例患者的麻醉效果来确定下一例患者所用DEX的剂量。当患者检查中出现难以忍受的腹胀腹痛，同时进行疼痛的视觉模拟评分（VAS），VAS≥7分则记录为阳性反应；反之，患者安静配合检查或VAS7分，则记录为阴性反应。若为阳性反应，，则下一例患者选择高一级别剂量的右美托咪定；若为阴性，则下一例选择低一级别的剂量。记录患者入室时（T0）、给予DEX后即刻(T1)、操作开始时(T2)、检查开始后5min(T3)、检查开始后10min (T4)、操作结束时(T5)的MAP、HR、RR、SpO2、BIS值。同时观察记录术中低血压、心动过缓、呼吸抑制及术后恶心、呕吐，低血糖反应，腹痛、腹胀，伤心哭泣、多语，躁狂等不良反应的发生。 结果： 1三组患者的年龄、性别构成比、检查时间比较差异无统计学意义（P0.05）； 2监测指标的比较 组间比较：三组各个时间点的MAP、HR、RR、SpO2、BIS值的比较差异无统计学意义（P0.05）。组内比较：三组T1-5的SpO2、RR与T0比较差异无统计学意义（P0.05）；三组T1-5的MAP、HR、BIS值均低于T0（P0.05）； 3不良反应的比较： ⑴术中心动过缓（HR50次/分）的例数:Ⅰ组0例，Ⅱ组1例，Ⅲ组1例。三组比较无差异（P0.05）；⑵术后恶心呕吐的例数：Ⅰ组0例，Ⅱ组0例，Ⅲ组1例，三组之间比较无差异（P0.05）；⑶术后低血糖反应的例数Ⅰ组1例，Ⅱ组0例，Ⅲ组0例，三组之间比较无差异（P0.05）；⑷三组术中均未出现低血压、呼吸抑制，术后均未出现腹痛、腹胀，伤心哭泣、多语，躁狂等情况。 4三组患者右美托咪定的ED50和95%可信区间： I组ED50是0.18ug/kg（95%CI0.15-0.22ug/k） II组ED50是0.25ug/kg（95%CI0.20-0.32ug/kg） III组ED50是0.40ug/kg（95%CI0.36-0.45ug/kg） 三组比较差异有统计学意义（P0.05）； 结论： 1体重因素影响右美托咪定复合瑞芬太尼用于结肠镜检查的临床效果，不同体重指数患者右美托咪定的ED50不同。 2体重指数≥24的患者右美托咪定的ED50是0.18ug/kg，体重指数介于18.5～24的患者右美托咪定的ED50是0.25ug/kg，体重指数≤18.5的患者右美托咪定的ED50是0.40ug/kg，体重指数越小右美托咪定的ED50越大。
[Abstract]:Objective: To study the effect of different body mass index (BMI) on dexmedetomidine (DEX) combined with remifentanil for painless colonoscopy.
Methods: a sequential method was used to determine the median effective dose (ED50) of dexmedetomidin and remifentanil for different body mass index patients undergoing colonoscopy. 55 patients with ASA I or class II receiving painless colonoscopy were selected, with a age of 40~64 years old and no abdominal hand history of gastrointestinal tract. The number was more than 24), group II (body mass index 18.5 ~ 24) and group III (body mass index < 18.5). All the patients were routinely prepared for bowel preparation before admission, the body position was set after admission, routine mask oxygen 5L/min, heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), respiratory frequency (RR), bispectral index (BIS), and so on. Open upper extremity veins were open. Each group was first given the DEX slow intravenous injection of 2min first. The initial dose of the first patient in each group was 0.3ug/kg. Then remifentanil was given 1ug/kg, the pump was pumped into 2min, then the maintenance 0.1ug/kg/min continued to pump, 2min began to operate, and the infusion of remifentanil was stopped at the end of the examination.
According to the sequential method, DEX was adjusted according to the 1.2 times step method. The anesthetic effect of one patient and above was determined to determine the dosage of DEX in the next patient. When the patient was examined, the unbearable abdominal pain, the visual analogue score of the pain (VAS), the VAS > 7 score was positive; and conversely, the patient was quiet. Combined examination or VAS7 score, a negative reaction was recorded. If the positive reaction was positive, the next patient selected a high level dose of right metomimidine; if negative, the next choice was selected at a lower level. The patient was recorded at the time of admission (T0), immediately after DEX (T1), at the beginning of operation (T2), 5min (T3) after examination, and 10min (T4) after the start of examination. MAP, HR, RR, SpO2, BIS value at the end of operation (T5). Meanwhile, observe the occurrence of adverse reactions such as hypotension, bradycardia, respiratory depression and postoperative nausea, vomiting, hypoglycemia, abdominal pain, abdominal distention, weeping, multilingual, manic and other adverse reactions.
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