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右美托咪定抑制内窥镜逆行胰胆管造影术中患者应激反应的效果
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DOI:
作者:
倪强,周新华,陈武荣,李炜,张计训,曹亦军,张明芝
NI Qiang,ZHOU Xin-hua,CHEN Wu-rong,LI Wei,ZHANG Ji-xun,CAO Yi-jun,ZHANG Ming-zhi
作者单位:
1.苏州大学2.上海中医药大学附属普陀医院
1 Soochow University 2 Department of Anesthesiology, Putuo Hospital to Shanghai University of Traditional Chinese Medicine
关键词:
【关键词】 右美托咪定;靶控输注;内窥镜逆行胰胆管造影;应激反应
【Key words】 Dexmedetomidine; Target controlled infusion; Endoscopic retrograde cholangiopancreatography; Stress response
摘要:
【摘要】目的 评价右美托咪定在抑制内窥镜逆行胰胆管造影(ERCP)术中患者应激反应的效果。方法 80例择期静脉麻醉下行ERCP术患者随机分为两组,试验组:T组右美托咪定复合丙泊酚靶控输注组(n=40),C组对照组咪唑安定复合丙泊酚靶控输注组(n=40)。T组以右美托咪定1μg/kg输注10min后,改为右美托咪定0.5μg/kg/h复合丙泊酚靶控输注,C组以咪唑安定0.02mg/kg单次静脉输注10min后复合丙泊酚靶控输注。两组丙泊酚靶控输注初始血浆靶浓度设定为3.0μg/ml,待患者睫毛反射消失后测定其效应室浓度,在此基础上增加1.5-1.7μg/ml为术中丙泊酚靶浓度,两组均以术中体动反应调节麻醉深度。记录两组术前(T0)、睫毛反射消失(T1)、进镜(T2)、odds括约肌切开(T3)、退镜(T4)时心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)和血糖的变化,比较两组患者睫毛反射消失时和随后三个时点的丙泊酚效应室浓度并作统计分析。结果 与基础值相比,T组HR略降低,C组HR略上升,两组组间差异有统计学意义(F=23.973 P<0.01);两组MAP组内比较差异有统计学意义,与T0时比较,T组与C组T1—T4时点明显下降(P<0.01),组间比较两组差异也有统计学意义(F=4.801,P=0.031<0.05); 两组血糖组内比较差异有统计学意义,与T0时比较,T组与C组T1—T3时点明显下降(P<0.01),差异有统计学意义,但组间比较两组差异没有统计学意义。T组患者T1至T4时点丙泊酚效应室浓度明显低于C组(P<0.01)。两组术中血氧饱和度较基础值均无明显变化。结论 右美托咪定可抑制ERCP术中患者部分应激反应。
【Abstract】Objective To evaluate of dexmedetomidine suppressed endoscopic retrograde cholangiopancreatography in patients with stress effect. Methods 80 patients of undergoing elective endoscopic retrograde cholangiopancreatography with intravenous anesthesia were randomly divided into experimental group with dexmedetomidine and propofol (group T) (n = 40) and control group with midazolam and propofol (group C) (n = 40). After atropine with the dose of 0.01mg/kg was given by intravenous infusion at the beginning of anesthesia, patients in T group were given dexmedetomidine with the dose of 1μg/kg for 10min, then were given dexmedetomidine with the dose 0.5μg/kg/h and propofol by target-controlled infusion; patients in C group were given midazolam with the dose of 0.02mg/kg by intravenous infusion for 10min, then were given propofol by target-controlled infusion. Two initial target-controlled infusion target plasma concentration is set to 3.0μg/ml, measured target effect concentration until the patient disappeared after the eyelash reflex, increasing its target effect concentration 1.5-1.7μg/ml to maintain intraoperative propofol target concentration, both groups body movement reaction adjust the depth of anesthesia. Heart rate(HR), mean arterial blood pressure(MAP), pulse oxygen saturation (SpO2) and plasma glucose were recorded with each patient at the time of T0 (before operation), T1 (the eyelash reflex), T2 (the mirror entered), T3 (odds sphincter was cut open), T4 (the mirror was withdrew). Propofol effect-site concentration at the time of T1 to T4 in both groups was also recorded. Results HR was not different at the different measurement time both in Group T and Group C, while HR was significantly different between T group and C group (F=23.973,P <0.01), and HR decreased in Group T, while HR increased in Group C. MAP was significantly different within group both Group T and Group C, and the levels of MAP at the time T1-T4 all decreased compared with that of T0 both in Group T and Group C (P <0.01). Level of MAP was statistically significant between Group T and Group C (F =4.801,P=0.031<0.05). Level of plasma glucose was statistically significant within group both in Group T and Group C. Compared with T0, level of plasma glucose all decreased at T1-T3 both in group T and group C (P <0.01). While there was no significant difference between Group T and Group C. Propofol effect-site concentration wile T1 to T4 were significantly lower in Group T than that in Group C (P<0.01). Conclusion Dexmedetomidine can reduce stress response of endoscopic retrograde cholangiopancreatography in patients.
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