右美托咪定联合芬太尼镇静在内镜下食管胃底静脉套扎术中的应用

Application of Dexmedetomidine combined with Fentanyl sedation in endoscopic variceal ligation

摘要:

目的??探讨右美托咪定联合芬太尼镇静用于内镜下食管胃底静脉套扎术（EVL）的有效性与安全性。方法?拟行EVL术的肝硬化患者80例，随机分成右美托咪定联合芬太尼组DF组和芬太尼组F组，每组各40例，两组患者术前10 min口服利多卡因胶浆10 ml表面麻醉，DF组术前10 min始匀速静脉泵入0.5μg/kg右美托咪定，术前2 min缓慢静脉推注芬太尼0.5μg/kg，F组术前2 min缓慢静脉推注芬太尼0.5μg/kg，记录两组患者Ramsay镇静评分、术中不良反应、患者的术中反应程度、患者满意度和操作医生的满意度，操作时间。结果?DF组的Ramsay镇静评分大于F组，患者的满意度、操作医生的满意度均优于F组，手术时间DF组小于F组，不良反应两组相似。结论?右美托咪定联合芬太尼清醒镇静用于EVL安全有效，优于单用芬太尼。

Abstract:

Objective?To investigate the effectiveness and safety of Dexmedetomidine combined with Fentanyl sedation in endoscopic variceal ligation (EVL).?Method?80 patients with liver cirrhosis underwent EVL were randomly divided into Dexmedetomidine combined with Fentanyl (DF group) and Fentanyl group (F group). All the the patients were given oral Lidocaine plasmagel 10 ml for surface anesthesia ten mintues before EVL. DF group then received intravenous infusion of Dexmedetomidine 0.5 μg/kg in ten minutes by infusion pump and slow intravenous injection of Fentanyl 0.5 μg/kg 2 minutes before EVL; F group received intravenous infusion of the same volume of normal saline of Dexmedetomidine 0.5 μg/kg in ten minutes by infusion pump and slow intravenous injection of Fentanyl 0.5 μg/kg 2 minutes before EVL. Ramsay sedation score, patient’s adverse reactions, intraoperative reaction score, patient’s satisfaction score, operation doctor satisfaction score, operation time were recorded.?Results?Patients Ramsay score in DF group was higher than F group, patient satisfaction, operation doctor satisfaction score were better than the F group, the operation time DF group was less than that of group F. Adverse reactions were similar in the two groups.?Conclusion?Conscious sedation of Dexmedetomidine combined with Fentanyl for EVL is safe and effective, which is better than use Fentanyl alone.