不同剂量右美托咪定复合乳化依托咪酯在无痛肠镜中的应用研究

发布时间：2018-06-26 07:52

本文选题：右美托咪定 + 乳化依托咪酯　；参考：《浙江大学》2014年硕士论文

【摘要】：研究背景：现代医学的发展,生活条件的改善,健康意识的加强,患者对肠镜检查的要求越来越高。麻醉状态下实施电子肠镜检查诊疗,不仅能消除患者的焦虑、紧张、恐惧情绪,提高了电子肠镜检查的准确率,同时能提高患者的耐受性、改善患者的自觉症状及降低肠镜操作难度,避免了以往因恐惧而拒绝检查或者检查时不配合操作而延长操作时间、甚至终止操作等情况。无痛肠镜要求麻醉诱导安全舒适、平稳,内镜操作者满意,麻醉后苏醒迅速而安全,患者无不适感。呼吸抑制是无痛肠镜的最常见并发症,严重者可致患者死亡。当前,丙泊酚是无痛肠镜最常使用的麻醉药物,但可引起一过性的呼吸抑制,与阿片类药物合用可加重呼吸抑制和苏醒延迟,并导致血流动力学不稳定,以及麻醉苏醒时的躁动、谵妄等。依托咪酯是临床较常用的静脉麻醉药,具有起效快,呼吸循环抑制轻等特点,也常用于无痛肠镜的检查,但诱导时易发生注射痛、肌阵挛和恶心呕吐等并发症。乳化依托咪酯的使用减少了依托咪酯的注射痛和恶心呕吐的发生率,但肌阵挛的发生率仍较高。虽有很多研究报道单次推注和持续输注乳化依托咪酯是安全可行的,并通过复合使用其他药物来减少乳化依托咪酯的不良反应,如复合咪达唑仑来减少乳化依托咪酯所致的肌阵挛,但总体效果都不理想。右美托咪定是一种新型的α2肾上腺素受体激动剂,具有镇静、镇痛和抗交感神经作用,能够减少镇静镇痛药物的使用量,降低心脑血管不良事件的发生率,且无呼吸抑制,具有独特的生理睡眠状态。有研究结果显示,右美托咪定能减少依托咪酯所致的肌阵挛发生,但是不同剂量右美托咪定复合乳化依托咪酯在无痛肠镜检查中的应用研究未有报道。研究目的：观察单次泵注不同剂量右美托咪定对乳化依托咪酯在无痛肠镜中应用的有效性以及不良反应的影响。研究方法：经伦理委员会批准,并获得患者或家属知情同意后,采用随机数字表法将80例拟行无痛肠镜的患者随机分入4组,在给予乳化依托咪酯麻醉前分别泵注0.9%氯化钠溶液(对照组)、右美托咪定0.6μg/kg (0.6μg/kg组)、右美托咪定1.0μg/kg(1.0μg/kg组)和右美托咪定1.4μg/kg (1.4μg/kg组),观察并记录4组乳化依托咪酯的剂量,患者血流动力学指标、苏醒时间、离室时间,肌阵挛、术后不良反应情况,以及术中操作医师和患者的满意度。研究结果：右美托咪定0.6μg/kg组、右美托咪定1.0μg/kg组、右美托咪定1.4μg/kg组的乳化依托咪酯诱导用量和总用量均显著低于对照组(P值均0.05),4组间的肠镜检查时间和患者清醒时间的差异均无统计学意义(P值均0.05),右美托咪定0.6μg/kg组、右美托咪定1.0μg/kg组患者的离室时间均显著短于对照组和右美托咪定1.4μg/kg组(P值均0.05)。4组间T0时间点的MAP、HR、SpO2的差异均无统计学意义(P值均0.05),对照组、右美托咪定0.6μg/kg组、右美托咪定1.0μg/kg组T1-T5时间点的MAP均显著低于右美托咪定1.4μg/kg组同时间点(P值均0.05),右美托咪定0.6μg/kg组、右美托咪定1.0μg/kg组T1、T2、T4、T5时间点的HR均显著低于对照组同时间点(P值均0.05),对照组、右美托咪定0.6μg/kg组、右美托咪定1.0μg/kg组T1、T2时间点的Sp02均显著高于右美托咪定1.4μg/kg组(P值均0.05)。右美托咪定0.6μg/kg组、右美托咪定1.0μg/kg组、右美托咪定1.4μg/kg组的肌阵挛、恶心呕吐发生率均显著低于对照组(P值均0.05),4组间注射痛和梦境发生率的差异均无统计学意义(P值均0.05)。右美托咪定0.6μg/kg组、1.0μg/kg组、1.4μg/kg组操作医师的满意率均显著高于对照组(P值均0.05),右美托咪定0.6μg/kg组、1.0μg/kg组患者满意率均显著高于对照组和右美托咪定1.4μg/kg组(P值均0.05)。结论：右美托咪定0.61μg/kg组和1.0μg/kg组单次注射复合乳化依托咪酯能够安全应用于无痛肠镜中,并且能够降低相应肌阵挛、恶心呕吐等不良反应的发生率。
[Abstract]:Research background:
The development of modern medicine, the improvement of living conditions, the strengthening of health awareness, and the increasing demand for the patient's examination of enteroscopy. The implementation of the electronic colonoscopy under anesthesia can not only eliminate the anxiety, tension, and fear of the patients, improve the accuracy of the electronic colonoscopy, but also improve the patient's tolerance and improve the patient's self - tolerance. The symptoms and the difficulty of reducing the operation of the enteroscopy, avoid the prior period of refusing to check or check or check the operation time, and even terminate the operation. The painless enteroscopy requires anesthesia induction safety, comfort, smooth, endoscopic operator satisfaction, rapid and safe recovery after anesthesia, and the patient's feeling of no pain. Respiratory depression is painless. The most common complication of colonoscopy is severe death.
At present, propofol is the most commonly used anesthetic in painless colonoscopy, but it can cause an excessive respiratory inhibition. Combined with opiates can aggravate respiratory depression and wake up delay, lead to hemodynamic instability, as well as restlessness and delirium in the wake of anaesthesia. The use of respiratory and circulation inhibition is also often used in the examination of painless colonoscopy, but it is prone to complications such as injection pain, myoclonus and nausea and vomiting. The use of etomidate emulsified reduces the incidence of injection pain and nausea and vomiting of etomidate, but the incidence of myoclonus is still high. Although many studies have reported single push and holding. Continuous infusion of etomidate is a safe and feasible way to reduce the adverse effects of emulsified etomidate by compound use of other drugs, such as midazolam compound to reduce the myoclonus caused by the emulsified etomidate, but the overall effect is not ideal. Dexmedetomidine is a new type of alpha 2 adrenergic receptor agonist, with sedative, town Pain and resistance to sympathetic nerve can reduce the use of sedative and analgesic drugs, reduce the incidence of adverse events in the heart and brain vessels, and have no respiratory inhibition, and has a unique physiological sleep state. The application of ometamidate in painless colonoscopy has not been reported.
The purpose of the study is:
Objective To observe the efficacy and adverse reactions of single dose infusion of dexmedetomidine in the application of emulsified etomidate in painless enteroscopy.
Research methods:
After the approval of the ethics committee and the informed consent of the patients or family members, 80 patients with painless enteroscopy were randomly divided into 4 groups by random numerals, 0.9% Sodium Chloride Solution (control group), right metomomidine 0.6 mu g/ kg (0.6 mu g/kg group), and right metomomidine 1 g/kg (1 mu g/kg group) before the anesthesia was given to the emulsified etomidate. The dosage of 4 groups of emulsified etomidate, the hemodynamic index, the time of waking up, the room time, the myoclonus, the postoperative adverse reaction, and the satisfaction of the operation doctors and patients were observed and recorded in the dosage of 4 groups of emulsified etomidate (1.4 Mu group) and right metodetomidine (1.4 u g/kg group).
The results of the study:
Dexmedetomidine group 0.6 g/kg, dexmedetomidine group 1 g/kg, right metomomomidine 1.4 mu g/kg group of emulsified etomidate induced dosage and total dosage were significantly lower than the control group (P values are 0.05), the 4 groups of enteroscopy time and patient waking time difference were not statistically significant (P value of 0.05), right metomomidin group 0.6 g/kg, right metomi The time of isolation of the 1 g/kg group was significantly shorter than that of the control group and the right metomomomidine group (0.05) of the 1.4 g/kg group (P value 0.05).4 group MAP, HR, SpO2 were not statistically significant (P value 0.05), the control group, right metomomidine 0.6 micron g/kg group, right metomomidin 1 mu g/kg group T1-T5 time points were significantly lower than right metomidine 1.4 The same time point (P value was 0.05), dexmedetomidine group 0.6 g/kg, T1, T2, T4, T5 time point in right metomomomididine group of T1, T2, T4, T5 time point was significantly lower than the control group at the same time point (P value 0.05), the control group, right metomomidine 0.6 Mu g/kg group, right metomomidin 1 mu g/kg group. 0.05). Right metodetomidine group 0.6 g/kg, right metomomomidine 1 u g/kg group, right metomomomidin group of myoclonus, the incidence of nausea and vomiting was significantly lower than the control group (P value is 0.05), the difference between the 4 groups of injection pain and dream incidence was not statistically significant (P value 0.05). Right metodetomidine group 0.6 mu, 1 u g/kg group, 1.4 u g/kg group exercise. The satisfaction rate of the doctors was significantly higher than that of the control group (P value 0.05), right metomomidine 0.6 g/kg group, and 1 mu g/kg group were significantly higher than the control group and right metomomidine group 1.4 g/kg group (P value 0.05).
A single injection of etomidate of right metodetomidine in 0.61 and 1 g/kg groups can be safely used in painless colonoscopy and can reduce the incidence of adverse reactions such as the corresponding myoclonus, nausea and vomiting.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614.24

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