發(fā)布時(shí)間：2018-04-25 00:26

  本文選題：右美托咪定 + 腸鏡��； 參考：《中國(guó)老年學(xué)雜志》2017年20期

【摘要】：目的分析不同麻醉方案在多發(fā)腸息肉老年患者中的應(yīng)用效果。方法擇期行腸鏡下多發(fā)腸息肉摘除術(shù)的72例老年患者隨機(jī)分為觀察組和對(duì)照組各36例。觀察組、對(duì)照組術(shù)中分別給予小劑量右美托咪定(DEX)聯(lián)合舒芬太尼、丙泊酚聯(lián)合舒芬太尼的麻醉方案,根據(jù)術(shù)中情況加用丙泊酚、麻黃堿、阿托品等。比較給藥前(T1)、置入腸鏡時(shí)(T2)、手術(shù)開始15 min(T3)、退鏡時(shí)(T4)、離開手術(shù)室(T5)的心率(HR)、呼吸頻率(RR)、平均動(dòng)脈壓(MAP)、血氧飽和度(SpO_2)、腦電雙頻指數(shù)(BIS)值及手術(shù)時(shí)間、蘇醒時(shí)間、術(shù)后恢復(fù)室(PACU)的停留時(shí)間、術(shù)中麻黃堿、阿托品、丙泊酚的應(yīng)用量、不良反應(yīng)。結(jié)果與T1相比,觀察組各時(shí)間點(diǎn)的HR、RR、MAP、SpO_2均未出現(xiàn)明顯變化(P0.05),僅T2、T3、T4的BIS值顯著降低(P0.05);對(duì)照組T2、T3、T4的RR、MAP、SpO_2、BIS值均顯著降低(P0.05),T5的MAP顯著升高(P0.05)。兩組T1的HR、RR、MAP、SpO_2、BIS值差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組T2、T3、T4的RR、MAP、SpO_2、BIS值均顯著高于對(duì)照組(P0.05)。兩組手術(shù)時(shí)間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組蘇醒時(shí)間、PACU的停留時(shí)間均顯著低于對(duì)照組(P0.05)。兩組均未應(yīng)用阿托品,觀察組術(shù)中未應(yīng)用麻黃堿,顯著低于對(duì)照組(P0.05)。觀察組術(shù)中丙泊酚用量顯著低于對(duì)照組(P0.05)。觀察組無(wú)低血壓、呼吸抑制、頭暈,2例術(shù)中明顯體動(dòng)和1例消化道不適。觀察組低血壓、呼吸抑制發(fā)生率顯著低于對(duì)照組(P0.05)。結(jié)論對(duì)行無(wú)痛腸鏡下多發(fā)息肉摘除術(shù)的老年患者而言,小劑量DEX聯(lián)合舒芬太尼對(duì)呼吸、循環(huán)的影響輕微,且鎮(zhèn)靜深度較低,患者可隨時(shí)被叫醒并配合操作,清醒鎮(zhèn)靜效果令人滿意。
[Abstract]:Objective to analyze the effect of different anesthetic schemes in elderly patients with multiple intestinal polyps. Methods Seventy-two elderly patients undergoing selective endoscopic polyp resection were randomly divided into observation group (n = 36) and control group (n = 36). In the observation group, the control group was given low dose dexmetomidine (DEX) combined with sufentanil, propofol and sufentanil respectively, and propofol, ephedrine and atropine were added according to the intraoperative conditions. The heart rate (HRP), respiratory frequency (RRV), mean arterial pressure (MAPP), oxygen saturation (SPO _ 2), bispectral index (BISs), recovery time, recovery time and recovery time were compared. The duration of postoperative recovery of PACUC, the amount of ephedrine, atropine, propofol, adverse reactions. Results compared with T1, there was no significant change in HR-RRP-MAPSpO2 at all time points in the observation group, but the BIS value of T2 + T3 + T4 was significantly lower than that of the control group (P _ (0.05)), while the MAP of the control group (T _ (2) T _ (3) T _ (4)) was significantly lower than that of the control group (P _ (0.05) P _ (0.05)). There was no significant difference in BIS between the two groups (P 0.05). In the observation group, the values of RRX MAPS-SpO2BIS were significantly higher than those of the control group (P 0.05). There was no significant difference in operation time between the two groups (P 0.05). The recovery time of PACU in the observation group was significantly lower than that in the control group (P 0.05). No atropine was used in both groups, and ephedrine was not used in the observation group, which was significantly lower than that in the control group (P 0.05). The dosage of propofol in the observation group was significantly lower than that in the control group (P 0.05). There was no hypotension, respiratory inhibition, obvious body movement in 2 cases and digestive tract discomfort in 1 case in the observation group. The incidence of hypotension and respiratory depression in the observation group was significantly lower than that in the control group (P 0.05). Conclusion for the elderly patients undergoing painless multiple polyposis resection, the effects of low dose DEX combined with sufentanil on respiration and circulation are slight, and the depth of sedation is low, patients can be woken up and cooperate with the operation at any time. The sober sedation effect is satisfactory.
【作者單位】： 濟(jì)南市第三人民醫(yī)院手術(shù)室麻醉科;
【分類號(hào)】：R614

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