右美托咪定单次负荷剂量联合丙泊酚用于老年患者内镜逆行胰胆管造影术（ERCP）深度镇静的效果：一项前瞻性随机研究。
Effectiveness of single loading dose of dexmedetomidine combined with propofol for deep sedation of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients: a prospective randomized study.
机构信息
Department of Anesthesiology, Gusu School, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, No.242 Guangji Road, Suzhou, Jiangsu, China.
出版信息
BMC Anesthesiol. 2022 Mar 28;22(1):85. doi: 10.1186/s12871-022-01630-8.
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure and requires deep sedation. Deep sedation with dexmedetomidine for the respiratory drive preserved has become popular in recent years. However, the use of dexmedetomidine in elderly patients is controversial because its adverse events are more common. The objective of this study was to investigate the effectiveness of a single loading dose of dexmedetomidine combined with propofol for deep sedation of ERCP in elderly patients.
METHODS
In this prospective randomized trial, 49 elderly patients undergoing ERCP were randomly allocated to the dexmedetomidine (DEX) or propofol (PRO) groups. The single loading dose of dexmedetomidine was set at 0.5 μg/kg at the start of anesthesia induction and loading for 10 min. The primary outcome was the cumulative dose of propofol. Secondary outcomes included time to awake, the frequency of airway interventions, and hemodynamics.
RESULTS
The intraoperative cumulative dose of propofol was lower in the DEX group (111.0 ± 12.6 μg/kg/min) than the PRO group (143.7 ± 23.4 μg/kg/min) (P < 0.001). There was no statistically significant difference in the time to awake between the two groups. The incidence of artificial airway interventions and hypotension in the PRO group (36%, 60%) were significantly higher than those in the DEX group (4.2%, 16.7%) (P = 0.011, P = 0.003, respectively). In addition, the occurrence of bradycardia increased significantly in the DEX group (58.3%) compared with the PRO group (12%) (P < 0.001).
CONCLUSIONS
The single loading dose of dexmedetomidine combined with propofol can reduce propofol consumption and artificial airway intervention and provide better hemodynamic stability than propofol for deep sedation in elderly patients during ERCP.
TRIAL REGISTRATION
www.chictr.org.cn (Registration number ChiCTR1900028069, Registration date 10/12/2019).
背景
内镜逆行胰胆管造影术（ERCP）是一种先进的内镜程序，需要深度镇静。近年来，使用右美托咪定进行呼吸驱动保留的深度镇静变得流行。然而，老年患者使用右美托咪定存在争议，因为其不良事件更为常见。本研究的目的是探讨右美托咪定单次负荷剂量联合异丙酚在老年患者 ERCP 深度镇静中的效果。
方法
在这项前瞻性随机试验中，49 名接受 ERCP 的老年患者被随机分配到右美托咪定（DEX）或异丙酚（PRO）组。麻醉诱导开始时，右美托咪定的单次负荷剂量设定为 0.5μg/kg，持续 10min。主要结局是异丙酚的累积剂量。次要结局包括苏醒时间、气道干预的频率和血流动力学。
结果
DEX 组术中异丙酚累积剂量（111.0±12.6μg/kg/min）低于 PRO 组（143.7±23.4μg/kg/min）（P<0.001）。两组苏醒时间无统计学差异。PRO 组人工气道干预和低血压的发生率（36%，60%）明显高于 DEX 组（4.2%，16.7%）（P=0.011，P=0.003）。此外，DEX 组心动过缓的发生率（58.3%）明显高于 PRO 组（12%）（P<0.001）。
结论
与异丙酚相比，右美托咪定单次负荷剂量联合异丙酚可减少异丙酚的消耗和人工气道干预，并为老年患者 ERCP 深度镇静提供更好的血流动力学稳定性。
试验注册
www.chictr.org.cn（注册号 ChiCTR1900028069，注册日期 2019 年 12 月 10 日）。
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