右美托咪定滴鼻对无痛结肠镜检查老年患者快速康复的影响*

Effects of intranasal dexmedetomidine on fast track recovery for elderly patients undergoing colonoscopy*

摘要:

目的 探讨右美托咪定滴鼻复合丙泊酚对老年患者行无痛结肠镜检查快速康复的影响。方法 选取桂林医学院附属医院60例行无痛结肠镜检查的老年患者，随机分为实验组及对照组，每组30例。实验组检查前30?min给予1?μg/kg右美托咪定滴鼻，对照组给予等量生理盐水滴鼻。两组患者均于检查前5 min缓慢推注2.0?mg/kg丙泊酚，在患者睫毛反射消失后，开始行结肠镜检查，根据术中体动情况，追加20～30?mg丙泊酚。记录两组患者滴鼻前（T0）、滴鼻后30?min（T1）、睫毛反射消失时（T2）、检查开始后5?min（T3）、术毕时（T4）5个时间点的平均动脉压（MAP）、心率（HR）及脉搏血氧饱和度（SpO2），记录术中丙泊酚用量、手术时间、苏醒时间、术中不良反应、苏醒后VAS评分和Ramsay镇静评分。结果 与T0比较，T3和T4时对照组MAP升高（P?<0.05）。与对照组比较，T3和T4时实验组MAP降低（P?<0.05）。围术期高血压发生率、心动过速发生率、体动率及呛咳出现率实验组均降低（P?<0.05）。实验组苏醒时间和丙泊酚用量均低于对照组（P?<0.05）。结论 术前30?min予以1?μg/kg右美托咪定滴鼻可减少老年患者无痛结肠镜检查术丙泊酚的用量，缩短苏醒时间，且不良反应少，促进老年患者早日康复。

Abstract:

Objective To investigate the effect of intranasal dexmedetomidine combined with propofol on the fast track recovery of elderly patients undergoing painless colonoscopy. Methods Sixty elderly patients undergoing painless colonoscopy were randomly divided into experimental group (group D) and control group (group C), 30 patients in each group. Group D was given 1?μg/kg dexmedetomidine nasal drops 30 minutes before examination, while the control group was given the same amount of normal saline nasal drops. 2.0?mg/kg propofol was injected slowly 5 minutes before the examination in both groups. After the eyelash reflex disappeared, colonoscopy was started, and 20 to 30 mg propofol was added according to the physical movement during the operation. The five time points were selected, including before nasal drip (T0), 30 minutes after nasal drip (T1), disappearance of eyelash reflex (T2), 5 minutes after examination (T3), and at the end of operation (T4). The mean arterial pressure (MAP), heart rate (HR), and pulse oxygen saturation (SpO2) were recorded. The dosage of propofol during operation, recovery time, intraoperative adverse reactions, VAS score after awaking, and Ramsay sedation score were recorded. Results Compared with T0, MAP in group C increased significantly at T3 and T4 (P?