本文選題：結腸鏡檢查 + 右美托咪定��； 參考：《河北醫(yī)科大學》2014年碩士論文

【摘要】：目的：研究不同體重指數(shù)對右美托咪定（DEX）復合瑞芬太尼用于無痛結腸鏡檢查的影響。 方法：應用序貫法測定右美托咪定復合瑞芬太尼用于不同體重指數(shù)患者行結腸鏡檢查時的半數(shù)有效劑量（ED50）。選擇ASAⅠ或Ⅱ級接受無痛結腸鏡檢查的患者55例，年齡40～64歲，無胃腸道等腹部手術史。將患者依體重指數(shù)分為Ⅰ組（體重指數(shù)為≥24）、Ⅱ組（體重指數(shù)18.5～24）、Ⅲ組（體重指數(shù)≤18.5）。全部患者在接受檢查前常規(guī)行腸道準備，入室后擺好體位，常規(guī)面罩吸氧5L/min，監(jiān)測心率（HR）、平均動脈壓（MAP）、血氧飽和度（SpO2）、呼吸頻率（RR）、腦電雙頻指數(shù)（BIS）等指標。開放上肢靜脈，各組均首先給予DEX緩慢靜注2min，每組第一例患者的初始劑量均為0.3ug/kg，之后給予瑞芬太尼負荷量1ug/kg,微量泵泵入2min，繼而改為維持量0.1ug/kg/min持續(xù)泵入，2min后開始操作，檢查結束時停止輸注瑞芬太尼。 根據(jù)序貫法，DEX按等比1.2倍的階梯法進行調(diào)整，每組以上一例患者的麻醉效果來確定下一例患者所用DEX的劑量。當患者檢查中出現(xiàn)難以忍受的腹脹腹痛，同時進行疼痛的視覺模擬評分（VAS），VAS≥7分則記錄為陽性反應；反之，患者安靜配合檢查或VAS7分，則記錄為陰性反應。若為陽性反應，，則下一例患者選擇高一級別劑量的右美托咪定；若為陰性，則下一例選擇低一級別的劑量。記錄患者入室時（T0）、給予DEX后即刻(T1)、操作開始時(T2)、檢查開始后5min(T3)、檢查開始后10min (T4)、操作結束時(T5)的MAP、HR、RR、SpO2、BIS值。同時觀察記錄術中低血壓、心動過緩、呼吸抑制及術后惡心、嘔吐，低血糖反應，腹痛、腹脹，傷心哭泣、多語，躁狂等不良反應的發(fā)生。 結果： 1三組患者的年齡、性別構成比、檢查時間比較差異無統(tǒng)計學意義（P0.05）； 2監(jiān)測指標的比較 組間比較：三組各個時間點的MAP、HR、RR、SpO2、BIS值的比較差異無統(tǒng)計學意義（P0.05）。組內(nèi)比較：三組T1-5的SpO2、RR與T0比較差異無統(tǒng)計學意義（P0.05）；三組T1-5的MAP、HR、BIS值均低于T0（P0.05）； 3不良反應的比較： ⑴術中心動過緩（HR50次/分）的例數(shù):Ⅰ組0例，Ⅱ組1例，Ⅲ組1例。三組比較無差異（P0.05）；⑵術后惡心嘔吐的例數(shù)：Ⅰ組0例，Ⅱ組0例，Ⅲ組1例，三組之間比較無差異（P0.05）；⑶術后低血糖反應的例數(shù)Ⅰ組1例，Ⅱ組0例，Ⅲ組0例，三組之間比較無差異（P0.05）；⑷三組術中均未出現(xiàn)低血壓、呼吸抑制，術后均未出現(xiàn)腹痛、腹脹，傷心哭泣、多語，躁狂等情況。 4三組患者右美托咪定的ED50和95%可信區(qū)間： I組ED50是0.18ug/kg（95%CI0.15-0.22ug/k） II組ED50是0.25ug/kg（95%CI0.20-0.32ug/kg） III組ED50是0.40ug/kg（95%CI0.36-0.45ug/kg） 三組比較差異有統(tǒng)計學意義（P0.05）； 結論： 1體重因素影響右美托咪定復合瑞芬太尼用于結腸鏡檢查的臨床效果，不同體重指數(shù)患者右美托咪定的ED50不同。 2體重指數(shù)≥24的患者右美托咪定的ED50是0.18ug/kg，體重指數(shù)介于18.5～24的患者右美托咪定的ED50是0.25ug/kg，體重指數(shù)≤18.5的患者右美托咪定的ED50是0.40ug/kg，體重指數(shù)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.
Result錛

本文編號：1968650