目的：探讨小剂量右美托咪定( DEX)联合丙泊酚麻醉在无痛纤维结肠镜检查中的应用效果及安全性。方法选择2013年6月—2014年2月在中国医科大学附属第一医院行无痛纤维结肠镜检查患者110例,随机分为DEX联合丙泊酚组(观察组)和舒芬太尼联合丙泊酚组(对照组),每组55例。观察组予0.5μg/kg DEX 10 ml联合1~1.5 mg/kg丙泊酚麻醉,对照组予0.5μg/kg舒芬太尼10 ml 联合丙泊酚1~1.5 mg/kg麻醉。检查过程患者如有体动反应影响操作,则追加丙泊酚0.2~0.5 mg/kg静脉注射。观察两组丙泊酚总用量、检查时间、苏醒时间、检查后30 min视觉模拟评分(VAS),检查前(T0)、给丙泊酚后5 min(T1)、过脾曲(T2)、过肝曲(T3)、检查结束(T4)时的平均动脉压(MAP)、心率(HR)及血氧饱和度(SpO2)以及不良反应发生情况。结果观察组丙泊酚总用量(110.5±15.7)mg明显低于对照组(150.3±19.5)mg(P0．05)；与对照组比较,T1~T3时间点观察组MAP、SpO2显著升高(P<0．05),T1~T4时间点HR显著降低(P<0．05)；观察组呼吸抑制、低血压、不良体动及肠绞痛的发生率明显低于对照组(P<0．05或P<0．01)。结论小剂量DEX联合丙泊酚用于无痛纤维结肠镜检查较舒芬太尼联合丙泊酚麻醉效果更佳,能够减少麻醉药用量,避免呼吸抑制和低血压的发生。%Objective This clinical study was conducted to investigate the anesthetic effect and safety of small dose of dexmedetomidine ( DEX) combined with propofol in patients undergoing painless colonoscopy. Methods A total of 110 patients undergoing painless colonoscopy during June 2013 to February 2014 in our hospital were selected. The patients were randomly di-vided into DEX combined with propofol (observation group, n=55) and sufentanil combined with propofol (control group, n=55). The patients in observation group were given DEX 0. 5 μg/kg (diluted to 10 ml) combined with 1-1. 5 mg/kg propofol, while the patients in the control group were given sufentanil 0. 5μg/kg (diluted to 10 ml) combined with 1-1. 5 mg/kg propofol. In some patients, additional doses of propofol (0. 2-0. 5 mg/kg) were given according to the body activity and operation time. The consumed dose of propofol, operation time, full recovery time, visual analog scale ( VAS) 30 min after operation, and ad-verse reactions were recorded. Mean arterial pressure ( MAP ) , heart rate ( HR ) , and hemoglobin oxygen saturation levels ( SpO2 ) at the time before check ( T0 ) , 5 min after propofol ( T1 ) , splenic flexure ( T2 ) , hepatic flexure ( T3 ) , and at the end (T4) were recorded. Results The total amount of propofol in observation group (110. 5 ± 15. 7) was significantly lower than that in the control group (150. 3 ± 19. 5). The operation time, full recovery time and VAS were similar in both groups. Com-pared with the control group, MAP and SpO2 were significantly increased at T1- T3(P<0. 05), HR decreased significantly at T1-T4(P<0. 05) in the observation group. The respiratory depression, hypotension, poor body movement, and intestinal angina in the observation group were significantly lower than that in the control group (P<0. 05 or P<0. 01). Conclusion The anes-thetic effect of small dose of DEX combined with propofol on patient undergoing painless colonoscopy is significantly better than that of sufentanil combined with propofol. The small dose of DEX combined with propofol can reduce the occurrence of the ad-verse reaction, reduced the dose of propofol, and avoid respiratory depression. Small dose of DEX combined with propofol is a safe and an effective anesthetic method for patients undergoing painless colonoscopy.
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