依托咪酯或丙泊酚联用右美托咪定用于胃食管反流病内镜下射频治疗镇静的效果比较*

Comparison of Etomidate-Dexmedetomidine and Propofol-Dexmedetomidine sedation in patients with gastroesophageal reflux disease treated by endoluminal radiofrequency ablation*

摘要:

目的??比较依托咪酯或丙泊酚联用小剂量右美托咪定用于胃食管反流病（GERD）患者射频治疗镇静的效果和安全性。方法?研究对象为确诊为GERD，拟行内镜下射频治疗的成年患者60例，随机等分入依托咪酯组或丙泊酚组。射频治疗镇静时，两组均静脉预注右美托咪啶0.2μg/kg，随即间断输注依托咪酯或丙泊酚。术中根据Ramsay镇静评分（5～6分）、患者反应调整药物用量。主要观察指标为射频治疗时间、麻醉时间、苏醒时间、循环呼吸不良事件（血压异常、心律异常、缺氧的发生率），次要观察指标包括麻醉前（T0）、进镜即刻（T1）、射频时（T2）、复查进镜即刻（T3）、治疗结束时（T4）患者的平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO2）、术中体动反应和医患满意度等。结果?两组患者射频治疗时间、麻醉时间和术后恢复时间差异无统计学意义。依托咪酯组心血管活性药物使用率（P =0.002）、心动过缓发生率（P =0.032）低于丙泊酚组，且T1（P =0.023）、T2（P =0.009）时SpO2高于丙泊酚组，其余指标两组差异均无统计学意义。结论?依托咪酯复合右美托咪啶用于GERD射频治疗时镇静，较丙泊酚循环呼吸更加稳定。

Abstract:

Objective?To compare the efficacy and safety of Etomidate-Dexmedetomidine and Propofol-Dexmedetomidine sedation in patients undergoing endoscopic radiofrequency ablation of gastroesophageal reflux disease (GERD).?Methods?Sixty adult patients, scheduled for elective endoluminal radiofrequency ablation for GERD under sedation were prospectively randomized into Etomidate-Dexmedetomidine (Group-E, n = 30) or Propofol-Dexmedetomidine (Group-P, n = 30) group. A bolus of 0.2 μg/kg of intravenous Dexmedetomidine was followed by intermittent Etomidate or Propofol injection during the procedure in order to maintain a proper depth of sedation with a Ramsay sedation scores of 5～6. Heart rates, mean blood pressure, oxygen saturation, respiratory rates and Ramsay sedation scores were recorded before sedation (T0), at the beginning of the examination (T1), during radiofrequency energy delivery (T2), at the time of gastroscopy (T3) and at the end of therapy (T4). Inter-group differences in sedation profiles (duration, time to recovery, incidence of body movement, Ramsay sedation scores and satisfaction of patient and endoscopist) and cardio-respiratory responses (heart rate, mean arterial pressure, oxygen saturation) were determined during and after radiofrequency ablation.?Results?No difference was found for therapy duration, anesthesia time or the time to recovery between Group-P and Group-E. Patients receiving Propofol experienced more bradycardia (Ρ = 0.032) and had higher incidences of vasoactives used (Ρ = 0.002) compared with that receiving Etomidate. Oxygen saturation in T1 (Ρ = 0.023) and T2 (Ρ = 0.009) was lower in the Group-P. No significant difference was found for other indicators. ?Conclusion?Etomidate-Dexmedetomidine sedation was superior to Propofol-Dexmedetomidine sedation for GERD radiofrequency therapy with more stable cardio-respiratory responses.