小剂量氯胺酮与瑞芬太尼复合右美托咪定在老年人治疗性内镜逆行胰胆管造影术中的比较

摘要

Objective To explore the effects of small dose of ketamine combined with dexmedetomidine for the endoscopic retrograde cholangiopancreatography ( ERCP) in the elderly patients. Methods One hundred patients undergoing ERCP were randomly and equally allocated into group KD (n=50) and group RD(n=50). Two groups received dexmedetomidine continuous infusion at the speed of 0. 5 μg/( kg·h) followed by 1 μg/kg intravenous injec-ton at 10 min before operation. Patients in group KD received ketamine 0. 4 mg/kg intravenous injection and 5 μg/( kg·min) continous infusion;Patients in group RD received remifentanil 0. 5 μg/kg intravenous injection and 0. 05μg/( kg·min) continous infusion. HR,MAP,SpO2 and RR were monitored and recorded before the anesthesia( T0 ) ,at the time points of operation beginning( T1 ) ,30 min after operation beginning( T2 ) ,at the time point of operation termi-nation (T3). Sedation effects of the patient were evaluated by Ramsay scores. The operation time,intraoperative and postoperative incidence of adverse reactions were recorded. The satisfaction of patient,anesthesiologist and surgeon were recorded too. Results In group RD,compared with T0,HR,MAP in T1 increased significantly(P<0. 05). Compared with group RD,the satisfaction of patient and sedation effect increased significantly in group KD (P<0. 05). Conclu-sion Small dose of ketamine combined with dexmedetomidine has better effect of sedation than that of the combina-tion of remifentanil and dexmedetomidine with higher safety.%目的 探讨小剂量氯胺酮复合右美托咪定在老年人治疗性内镜逆行胰胆管造影术( ERCP)的应用效果. 方法 选择100例行ERCP的患者,采用随机数字表法,将其分为2 组,每组50 例:氯胺酮+右美托咪定组( KD组)和瑞芬太尼+右美托咪定组( RD组). 两组患者均于手术前10 min静脉推注右美托咪定1 μg/kg,然后持续泵注右美托咪定0. 5 μg/( kg·h). 于手术开始时,KD组静脉推注0. 4 mg/kg氯胺酮,然后持续泵注氯胺酮5 μg/( kg·min);RD组静脉推注瑞芬太尼0. 5 μg/kg,随后持续输注瑞芬太尼0. 05 μg/( kg·h). 并记录给药前(T0)、手术开始时(T1)、手术开始后30 min(T2)、术毕时(T3)的平均动脉压(MAP)、心率(HR)、呼吸( RR)、脉搏氧饱和度( SpO2 )的变化;用Ramsay镇静评分来评价患者的镇静效果;记录手术时间、术中术后不良反应发生率及患者、麻醉医生和手术医生的满意度等. 结果 与T0 时相比,RD组患者T1 时HR、BP明显升高(P<0. 05);与RD组相比,KD组术后患者满意度明显增高(P<0. 05),且镇静满意的比例明显增高(P<0. 05).结论 小剂量氯胺酮复合右美托咪定用于ERCP中,可获得更满意的镇痛、镇静效果,且更安全.