小剂量右美托咪定联合丙泊酚在无痛纤维结肠镜检查中的应用

发布时间：2018-04-02 21:44

本文选题：无痛纤维结肠镜　切入点：丙泊酚　出处：《郑州大学》2017年硕士论文

【摘要】：目的探讨小剂量右美托咪定(DEX)联合丙泊酚在无痛纤维结肠镜检查中的应用效果及安全性,可以为临床进行无痛纤维结肠镜检查患者提供最佳的麻醉方法,减少患者检查中的痛苦,保证检查过程中的安全。方法本研究采用随机分组、平行对照的方式进行研究,选取于我院(河南省人民医院)行无痛纤维结肠镜检查的186例患者进行研究,采用随机数字表法将患者随机分为单纯组、复合Ⅰ组和复合Ⅱ组,每组各62例,采用顺序编码、不透光信封密封的完全隐藏方式,由对本研究相关内容不知情的临床医生招募符合纳入条件的患者,确认患者符合纳入标准并签署知情同意书后领取密封信封,打开信封后按照提示对患者进行相应的麻醉干预。其中单纯组患者为单纯丙泊酚麻醉,给予患者静注丙泊酚1.5mg/kg;复合Ⅰ组为芬太尼复合丙泊酚麻醉,芬太尼1.0μg/kg,再静脉注射丙泊酚1.5mg/kg;复合Ⅱ组为右美托咪定复合丙泊酚麻醉,即10min内通过静脉泵入右美托咪定0.5μg/kg,然后静脉注射丙泊酚1.5mg/kg。两组患者待睫毛反射消失后行纤维结肠镜检查,术中发生体动反应时,间断追加丙泊酚1mg/kg。记录给药前(T0)、纤维结肠镜检查前(T1)、过脾曲时(T2)、过肝曲时(T3)及检查结束时(T4)的HR、MAP、RR和SPO2;记录起效时间、苏醒时间(检查结束至患者睁眼的时间)、离院时间(患者清醒至离开检查室的时间)、记录术中右美托咪定和丙泊酚的用量、记录术中发生情况及体动反应程度;观察治疗后30min后患者疼痛情况,分析右美托咪定复合丙泊酚用于无痛纤维结肠镜检查术的临床疗效及安全性。结果1、三组患者性别、年龄、ASA评分、体重以及检查时间比较无显著差异(P0.05)。2、三组患者T0时间段内HR、MAP、RR和Sp O2监测结果差异无统计学意义(P均0.05);HR结果监测中显示,给药后三组患者均出现不同程度的降低,与同组T0比较具有明显的统计学差异(P0.05);单纯组患者给药后至检查结束其HR变化较为明显,单纯组HR在T2~T4时间内监测值与复合Ⅱ组具有显著的统计学差异(P均0.05);RR监测结果中显示,三组患者在给药后RR变化较为明显,T1~T4时间内均与T0具有显著的统计学差异(P0.05);且单纯组在T3时间段内与复合Ⅱ组差异具有统计学意义(P0.05)。3、复合Ⅱ组与复合Ⅰ组在给药后起效时间、苏醒时间、离院时间以及丙泊酚用量四个方面均明显优于单纯组,差异比较(P均0.05);且复合Ⅱ组在四个方面均优于复合Ⅰ组,差异比较(P均0.05)。4、单纯组、复合Ⅰ组和复合Ⅱ组体动发生率分别为51.61%、35.48%和11.29%,三组差异比较具有显著的统计学意义(P0.05)。5、单纯组、复合Ⅰ组和复合Ⅱ组镇痛效果优良率分别为61.29%、72.58%和90.32%,三组差异比较具有显著的统计学意义(P0.05)。6、单纯组不良反应发生例数较多,其在舌后坠、明显血压下降、呼吸抑制、躁动以及头晕不良反应发生例数明显高于复合Ⅱ组,差异比较(P均0.05);单纯组与复合Ⅰ组在呼吸抑制发生例数中具有明显差异(P0.05);复合Ⅰ组与复合Ⅱ组在躁动、头晕不良反应发生例数中具有显著的差异(P0.05)。结论1、芬太尼、右美托咪定联合丙泊酚在无痛纤维结肠镜临床麻醉中能够明显减少丙泊酚药物用量,右美托咪定更优。2、小剂量右美托咪定联合丙泊酚在无痛纤维结肠镜临床麻醉中具有起效快、呼吸影响小、苏醒相对迅速、不良反应少的特点。
[Abstract]:Objective to investigate the effect of small dose of dexmedetomidine (DEX) combined with propofol application in colonoscopy and safety, can provide the best anesthesia method for painless colonoscopy patients for clinical examination, reduce patient pain, ensure the inspection process safety. Based on the method of random grouping study, parallel control mode selection in our hospital (Henan Province People's Hospital) of 186 patients undergoing painless colonoscopy were randomly were randomly divided into two groups, group I and II composite composite group, 62 cases in each group, using sequence encoding, completely hidden opaque envelopes the seal, from the content of this study recruited clinicians unaware of the eligible patients, confirmed patients met the inclusion criteria and signed informed consent to receive a sealed envelope, Open the envelope after anesthesia according to the prompt intervention on patients. The patients with simple group propofol anesthesia, patients were given intravenous injection of propofol 1.5mg/kg group I; compound fentanyl combined with propofol anesthesia, fentanyl 1 g/kg, intravenous injection of propofol 1.5mg/kg composite; group II, dexmedetomidine combined with propofol anesthesia, 10min by intravenous infusion of dexmedetomidine 0.5 g/kg and intravenous injection of propofol 1.5mg/kg. two group patients after loss of eyelash reflex colonoscopy, body movement during surgery, intermittent additional propofol 1mg/kg. recorded before administration (T0), fiber colonoscopy (T1), after the spleen when the music (T2), liver (T3). And at the end of the examination (T4) of HR, MAP, RR and SPO2; record the onset time, recovery time (check until the end of time, with open eyes) from the hospital (between the awake patients to leave the examination room time), Intraoperative dexmedetomidine and propofol dosage were recorded, and the incidence of body movement; the pain of patients after treatment were observed after 30min analysis, the effects of dexmedetomidine and propofol for clinical efficacy and safety of painless colonoscopy. Results 1, three groups of patients with gender, age, ASA score and there is no significant difference between body weight and inspection time (P0.05).2, three groups of T0 patients with time period of HR, MAP, RR and Sp O2 had no statistically significant difference monitoring results (P 0.05); according to monitoring results of HR, after administration of three groups of patients were reduced to different degrees, compared with the same group T0 has a statistically significant difference (P0.05); control group patients after administration to check the end of the HR more obvious changes, the simple group HR monitoring value have a statistically significant difference in T2~T4 group and compound II Time (P 0.05); RR monitoring results, three groups of patients After the administration of RR more obvious changes, T1~T4 time and T0 were statistically significant difference (P0.05); and the control group in period T3 and compound II group differences were statistically significant (P0.05.3), group II and group I composite composite onset time, recovery time after administration, from the hospital time and dosage of propofol four were significantly better than the simple group, the difference (P 0.05); and the composite group II in four aspects are better than that of compound I group, the difference (P 0.05).4, simple group, compound group I and group II composite body movement occurred in 51.61% and 35.48%. 11.29%, compare the differences between the three groups was statistically significant (P0.05.5), simple group, compound group I and II composite group the excellent rate of analgesic effect were 61.29%, 72.58% and 90.32%, compared the differences between the three groups was statistically significant (P0.05.6), the pure group of adverse reaction cases in which the number of tongue After the fall, significantly decreased blood pressure, respiratory depression, restlessness, dizziness and adverse reaction incidence was significantly higher than that of compound II were compared (P 0.05); simple group and complex group had significant differences in the incidence of respiratory depression (P0.05); group I and group II composite compound in agitation, adverse reactions and dizziness the number of cases with significant difference (P0.05). Conclusion: 1, fentanyl, dexmedetomidine combined with propofol can reduce the dosage of propofol anesthesia in painless colonoscopy in clinic, dexmedetomidine better.2, small doses of dextromethorphan support medetomidine combined with propofol in painless colonoscopy with clinical rapid onset of respiratory effects of small, relatively rapid recovery, less adverse reaction.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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