【摘要】 目的 比较右美托咪啶与丙泊酚复合地佐辛在内镜黏膜下剥离术（ESD）中的麻醉效果。方法 行ESD手术患者80例,ASA分级Ⅰ或Ⅱ级。采用随机数字表法,将80例患者分为丙泊酚组（P组）和右美托咪啶组（D组）两组,每组各40例。P组患者诱导缓慢推注丙泊酚0.5¹.0 mg/kg,后以每小时3 mg/kg持续泵注丙泊酚。D组于术前10分钟缓慢泵注右美托咪啶,负荷剂量1μg/kg,再以每小时0.3 ug/kg剂量持续泵注右美托咪啶。两组患者均在治疗前静脉给予地佐辛0.05 mg/kg。记录两组患者给药前（T₀）、手术开始即刻（T₁）、开始后5分钟（T₂）、开始后20分钟（T₃）、术毕时（T₄）心率（HR）、平均动脉压（MAP）、呼吸（RR）、血氧饱和度（SpO₂）变化。记录丙泊酚追加量,手术时间,苏醒时间,并记录患者不良反应及VAS镇痛评分。结果 与T₀时比较,P组HR和MAP在T₁时显著降低,T₂和T₃时显著增加（P<0.05）;D组T₁时仅HR较T₀显著降低（P<0.01）,T₂和T₃时与T₀比较差异无统计学意义。D组T₁时MAP明显高于P组,而T₂和T₃时D组HR和MAP均较P组低。P组SpO₂在T₂、T₃时明显降低,且T₃时与D组比较差异有统计学意义（P<0.05）。与P组比较,D组术中呼吸暂停发生率、体动的发生率及术后VAS评分均较低,两组比较差异有统计学意义（P<0.05）。P组手术时间明显长于D组。结论 与丙泊酚比较,右美托咪啶具有更强的镇痛作用,更弱的呼吸抑制作用。右美托咪啶复合地佐辛在内镜黏膜下剥离术中能提供较好的镇静镇痛及安全保障。更多还原

【Abstract】 Objective To evaluate the clinical effect and safety of dexmedetomidine combined with dezocine in endoscopic submucosal dissection（ESD）.Methods Eighty ASA I or H patients,aged 39- 65 years old,weighing 45 76 kg,undergoing ESD,were randomly assigned into the following two groups（n=40 each） with random numerical table:propofol group(P group,iv infusion of propofol 0.5 ¹.0 mg/kg over 1 min followed by continuous infusion at 3 mg · kg^-1.h^-1) and dexmedetomidine group(D group,Dexmedetomidine was infused at a rate of 0.3 ug · kg^-1.h^-1 after a loading dose of 1 ug.kg^-1 over10 min before sugery).All the patients received i.v.infusion with dezocine 0.05mg/kg before the treatment.The mean arterial pressure（MAP）,heart rate（HR）,respiratory rate（RR）and pulse oxygen saturation（SpO₂） were recorded before infusion（T₀）,at the start of treatment（T₁）,5 min after the start of treatment（T₂）,20 min after start（T₃） and the ending of surgery（T₄）.Additional doses of propofol,operating time,recovery time,side effects and post-operative VAS scores were recorded as well.Results As compared with T0,the average level of HR and MAP in P group decreased significantly at T1 and increased significandy at T₂ and T₃（P <0.05）.While HR level in D group decreased significantly at T₁（P <0.01）and there were no difference at T₂ or T₃,and the MAP level at T₁ was much more higher than that in P group whereas the HR and MAP levels at T₂ and T₃ were comparatively lower.SpO₂ at T₂ and T₃ in P group was decreased significantly and there was significant difference at T3 between two groups.Compared with P group,the incidence of apnea and body movement were significandy decreased in D group.And the post-operative VAS scores were significantly lower in D group（P <0.05）.And the operating time was prolonged in P group.Conclusion Compared with propofol,dexmedetomidine has stronger analgesia effect and weaker respiratory inhibition side effect.The combined application of dexmedetomidine and dezocine will provide satisfactory analgesia and sedative effect as well as safety insurance for patients undergoing ESD.更多还原