| 摘要: |
| 目的评价丙泊酚、丙泊酚复合瑞芬太尼或右美托咪啶用于内镜下食管胃底静脉曲张结扎术的镇静效果和安全性。方法选择内镜下行肝硬化食管胃底静脉曲张结扎术患者75例，按随机数字表法分为丙泊酚组（P组）、丙泊酚分复合瑞芬太尼（PR组）和右美托咪啶复合丙泊酚组（DP组），每组各25例。3组患者给予丙泊酚靶控输注（TCI），效应室浓度以1.0μg/ml开始，以0.3μg/ml上调；PR组瑞芬太尼TCI效应室浓度1.5ng/ml；DP组手术开始前15min先静脉注射右美托咪啶0.5μg/kg，10min后持续给予右美托咪啶0.3μg/（kg·h）静脉注射。记录并比较麻醉前（T1）、达到合适镇静深度内镜置入前（T2）和治疗结束后（T3）时点MAP、HR和SpO2，术中低氧血症、体动、呛咳等不良事件，丙泊酚用量、手术时间、患者苏醒恢复时间和术后头晕等情况；评估内镜医师和患者的满意度。结果PR组和DP组在T2时点MAP和HR较P组明显降低（P＜0.05），DP组在T2时点SpO2较P组升高（P＜0.01）；PR组和DP组恢复时间、丙泊酚浓度、体动、呛咳和术后头晕发生率较P组均明显降低（P＜0.05或0.01），而患者和手术医师的满意度则明显增高；RP组低氧血症发生率较P组均明显增高，DP组则降低（P＜0.05或0.01）；DP组低氧血症发生率和内镜医师满意度较RP组升高（均P＜0.05）。结论丙泊酚复合瑞芬太尼或右美托咪啶用于内镜下食管胃底静脉曲张结扎术镇静效果优于单纯使用丙泊酚，但丙泊酚复合瑞芬太尼会增加呼吸抑制风险。 |
| 关键词: 内镜下食管胃底静脉曲张结扎 瑞芬太尼 右美托咪啶 丙泊酚 肝硬化 |
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| Comparison of three sedation regimens for endoscopic variceal ligation in patients with cirrhosis |
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WANG Mingcang, CHEN Lingyang, ZHOU Chunlian, WANG Huiqin
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Taizhou Hospital
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| Abstract: |
| Objective To compare the efficacy and safety of three sedation regimens for cirrhotic patients undergoing endoscopic variceal ligation. Methods Seventy-five ASA Ⅰ -Ⅲ patients with cirrhosis scheduled for endoscopic variceal ligation were divided into propofol (group P), propofol plus remifentanil (group PR) and dexmedetomidine plus propofol (group DP) groups with 25 in each group. All patients received target controlled infusion of propofol with initial effect-site doses 1.0μg/ml, then adjusted to appropriate concentrations. In addition patients in group RP received remifentanil effect-site concentrations
1.5ng/ml; patients in group DP received dexmedetomidine at 0.3μg/kg/h after receiving loading dose of 0.5μg/kg for 10min. MAP, HR and SPO2 were record before anesthesia (T1), before intubation (T2) and after surgery (T3). Incidence of body movement, cough reflex and desturation during operation and dizzy after operation were documented. Consumption of propofol, operation and recovery times were recorded. The satisfaction of patients and endoscopists was also documented. Results MAP and HR at T2, propofol consumption, recovery times , incidence of body movement and cough reflex during operation and dizzy afteroperation in group PR and DP were significantly lower than those in group P (P＜0.05, P＜0.01), while the satisfaction of patients and endoscopists were significantly higher (P＜0.05, P＜0.01). SpO2 in group DP and incidence of desturation in group PR were significantly higher than in group P(P＜0.01, P＜0.05). Incidence of desturation was significantly lower in group DP than that in group PR (P＜0.05), while the satisfaction of endoscopists were significantly higher (P＜0.05). Conclusion Sedation with propofol plus remifentanil or dexmedetomidine for endoscopic variceal ligation is superior to propofol target-controlled infusion, but propofol combination with remifentanil increased respiratory risk and incidence of hypoxemia. |
| Key words: Endoscopic variceal ligation Remifentanil Dexmedetomidine Propofo Cirrhosis |
