本文選題：無痛纖維結腸鏡　切入點：丙泊酚　出處：《鄭州大學》2017年碩士論文

【摘要】：目的探討小劑量右美托咪定(DEX)聯合丙泊酚在無痛纖維結腸鏡檢查中的應用效果及安全性,可以為臨床進行無痛纖維結腸鏡檢查患者提供最佳的麻醉方法,減少患者檢查中的痛苦,保證檢查過程中的安全。方法本研究采用隨機分組、平行對照的方式進行研究,選取于我院(河南省人民醫(yī)院)行無痛纖維結腸鏡檢查的186例患者進行研究,采用隨機數字表法將患者隨機分為單純組、復合Ⅰ組和復合Ⅱ組,每組各62例,采用順序編碼、不透光信封密封的完全隱藏方式,由對本研究相關內容不知情的臨床醫(yī)生招募符合納入條件的患者,確認患者符合納入標準并簽署知情同意書后領取密封信封,打開信封后按照提示對患者進行相應的麻醉干預。其中單純組患者為單純丙泊酚麻醉,給予患者靜注丙泊酚1.5mg/kg;復合Ⅰ組為芬太尼復合丙泊酚麻醉,芬太尼1.0μg/kg,再靜脈注射丙泊酚1.5mg/kg;復合Ⅱ組為右美托咪定復合丙泊酚麻醉,即10min內通過靜脈泵入右美托咪定0.5μg/kg,然后靜脈注射丙泊酚1.5mg/kg。兩組患者待睫毛反射消失后行纖維結腸鏡檢查,術中發(fā)生體動反應時,間斷追加丙泊酚1mg/kg。記錄給藥前(T0)、纖維結腸鏡檢查前(T1)、過脾曲時(T2)、過肝曲時(T3)及檢查結束時(T4)的HR、MAP、RR和SPO2;記錄起效時間、蘇醒時間(檢查結束至患者睜眼的時間)、離院時間(患者清醒至離開檢查室的時間)、記錄術中右美托咪定和丙泊酚的用量、記錄術中發(fā)生情況及體動反應程度;觀察治療后30min后患者疼痛情況,分析右美托咪定復合丙泊酚用于無痛纖維結腸鏡檢查術的臨床療效及安全性。結果1、三組患者性別、年齡、ASA評分、體重以及檢查時間比較無顯著差異(P0.05)。2、三組患者T0時間段內HR、MAP、RR和Sp O2監(jiān)測結果差異無統(tǒng)計學意義(P均0.05);HR結果監(jiān)測中顯示,給藥后三組患者均出現不同程度的降低,與同組T0比較具有明顯的統(tǒng)計學差異(P0.05);單純組患者給藥后至檢查結束其HR變化較為明顯,單純組HR在T2~T4時間內監(jiān)測值與復合Ⅱ組具有顯著的統(tǒng)計學差異(P均0.05);RR監(jiān)測結果中顯示,三組患者在給藥后RR變化較為明顯,T1~T4時間內均與T0具有顯著的統(tǒng)計學差異(P0.05);且單純組在T3時間段內與復合Ⅱ組差異具有統(tǒng)計學意義(P0.05)。3、復合Ⅱ組與復合Ⅰ組在給藥后起效時間、蘇醒時間、離院時間以及丙泊酚用量四個方面均明顯優(yōu)于單純組,差異比較(P均0.05);且復合Ⅱ組在四個方面均優(yōu)于復合Ⅰ組,差異比較(P均0.05)。4、單純組、復合Ⅰ組和復合Ⅱ組體動發(fā)生率分別為51.61%、35.48%和11.29%,三組差異比較具有顯著的統(tǒng)計學意義(P0.05)。5、單純組、復合Ⅰ組和復合Ⅱ組鎮(zhèn)痛效果優(yōu)良率分別為61.29%、72.58%和90.32%,三組差異比較具有顯著的統(tǒng)計學意義(P0.05)。6、單純組不良反應發(fā)生例數較多,其在舌后墜、明顯血壓下降、呼吸抑制、躁動以及頭暈不良反應發(fā)生例數明顯高于復合Ⅱ組,差異比較(P均0.05);單純組與復合Ⅰ組在呼吸抑制發(fā)生例數中具有明顯差異(P0.05);復合Ⅰ組與復合Ⅱ組在躁動、頭暈不良反應發(fā)生例數中具有顯著的差異(P0.05)。結論1、芬太尼、右美托咪定聯合丙泊酚在無痛纖維結腸鏡臨床麻醉中能夠明顯減少丙泊酚藥物用量,右美托咪定更優(yōu)。2、小劑量右美托咪定聯合丙泊酚在無痛纖維結腸鏡臨床麻醉中具有起效快、呼吸影響小、蘇醒相對迅速、不良反應少的特點。
[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.

【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

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