本文選題：無(wú)痛纖維結(jié)腸鏡　切入點(diǎn)：丙泊酚　出處：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的探討小劑量右美托咪定(DEX)聯(lián)合丙泊酚在無(wú)痛纖維結(jié)腸鏡檢查中的應(yīng)用效果及安全性,可以為臨床進(jìn)行無(wú)痛纖維結(jié)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(guò)程中的安全。方法本研究采用隨機(jī)分組、平行對(duì)照的方式進(jìn)行研究,選取于我院(河南省人民醫(yī)院)行無(wú)痛纖維結(jié)腸鏡檢查的186例患者進(jìn)行研究,采用隨機(jī)數(shù)字表法將患者隨機(jī)分為單純組、復(fù)合Ⅰ組和復(fù)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(duì)本研究相關(guān)內(nèi)容不知情的臨床醫(yī)生招募符合納入條件的患者,確認(rèn)患者符合納入標(biāo)準(zhǔn)并簽署知情同意書后領(lǐng)取密封信封,打開信封后按照提示對(duì)患者進(jìn)行相應(yīng)的麻醉干預(yù)。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(fù)合Ⅰ組為芬太尼復(fù)合丙泊酚麻醉,芬太尼1.0μg/kg,再靜脈注射丙泊酚1.5mg/kg;復(fù)合Ⅱ組為右美托咪定復(fù)合丙泊酚麻醉,即10min內(nèi)通過(guò)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(jié)腸鏡檢查,術(shù)中發(fā)生體動(dòng)反應(yīng)時(shí),間斷追加丙泊酚1mg/kg。記錄給藥前(T0)、纖維結(jié)腸鏡檢查前(T1)、過(guò)脾曲時(shí)(T2)、過(guò)肝曲時(shí)(T3)及檢查結(jié)束時(shí)(T4)的HR、MAP、RR和SPO2;記錄起效時(shí)間、蘇醒時(shí)間(檢查結(jié)束至患者睜眼的時(shí)間)、離院時(shí)間(患者清醒至離開檢查室的時(shí)間)、記錄術(shù)中右美托咪定和丙泊酚的用量、記錄術(shù)中發(fā)生情況及體動(dòng)反應(yīng)程度;觀察治療后30min后患者疼痛情況,分析右美托咪定復(fù)合丙泊酚用于無(wú)痛纖維結(jié)腸鏡檢查術(shù)的臨床療效及安全性。結(jié)果1、三組患者性別、年齡、ASA評(píng)分、體重以及檢查時(shí)間比較無(wú)顯著差異(P0.05)。2、三組患者T0時(shí)間段內(nèi)HR、MAP、RR和Sp O2監(jiān)測(cè)結(jié)果差異無(wú)統(tǒng)計(jì)學(xué)意義(P均0.05);HR結(jié)果監(jiān)測(cè)中顯示,給藥后三組患者均出現(xiàn)不同程度的降低,與同組T0比較具有明顯的統(tǒng)計(jì)學(xué)差異(P0.05);單純組患者給藥后至檢查結(jié)束其HR變化較為明顯,單純組HR在T2~T4時(shí)間內(nèi)監(jiān)測(cè)值與復(fù)合Ⅱ組具有顯著的統(tǒng)計(jì)學(xué)差異(P均0.05);RR監(jiān)測(cè)結(jié)果中顯示,三組患者在給藥后RR變化較為明顯,T1~T4時(shí)間內(nèi)均與T0具有顯著的統(tǒng)計(jì)學(xué)差異(P0.05);且單純組在T3時(shí)間段內(nèi)與復(fù)合Ⅱ組差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。3、復(fù)合Ⅱ組與復(fù)合Ⅰ組在給藥后起效時(shí)間、蘇醒時(shí)間、離院時(shí)間以及丙泊酚用量四個(gè)方面均明顯優(yōu)于單純組,差異比較(P均0.05);且復(fù)合Ⅱ組在四個(gè)方面均優(yōu)于復(fù)合Ⅰ組,差異比較(P均0.05)。4、單純組、復(fù)合Ⅰ組和復(fù)合Ⅱ組體動(dòng)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(jì)學(xué)意義(P0.05)。5、單純組、復(fù)合Ⅰ組和復(fù)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(jì)學(xué)意義(P0.05)。6、單純組不良反應(yīng)發(fā)生例數(shù)較多,其在舌后墜、明顯血壓下降、呼吸抑制、躁動(dòng)以及頭暈不良反應(yīng)發(fā)生例數(shù)明顯高于復(fù)合Ⅱ組,差異比較(P均0.05);單純組與復(fù)合Ⅰ組在呼吸抑制發(fā)生例數(shù)中具有明顯差異(P0.05);復(fù)合Ⅰ組與復(fù)合Ⅱ組在躁動(dòng)、頭暈不良反應(yīng)發(fā)生例數(shù)中具有顯著的差異(P0.05)。結(jié)論1、芬太尼、右美托咪定聯(lián)合丙泊酚在無(wú)痛纖維結(jié)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(lián)合丙泊酚在無(wú)痛纖維結(jié)腸鏡臨床麻醉中具有起效快、呼吸影響小、蘇醒相對(duì)迅速、不良反應(yīng)少的特點(diǎn)。
[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(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614

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