右美托咪定作为丙泊酚辅助用药用于择期内镜逆行胰胆管造影术患者的双盲随机对照研究
Dexmedetomidine as an Adjunct to Propofol in Patients Undergoing Elective Endoscopic Retrograde Cholangio-Pancreaticography - A Double-blind Randomized Controlled Study.
作者信息
Babu T Raghavendra, Kumar M R Anil, Anup N R, Shetty Sarika M
机构信息
Department of Anesthesiology, Jagadguru Shri Shivarathreshwara Academy of Higher Education and Research, Mysuru, Karnataka, India.
出版信息
J Pharm Bioallied Sci. 2024 Feb;16(Suppl 1):S399-S402. doi: 10.4103/jpbs.jpbs_617_23. Epub 2024 Feb 29.
BACKGROUND
Propofol is the drug of choice for procedural sedation. The addition of α agonist dexmedetomidine may improve the safety profile of the procedure by providing stable hemodynamics, better sedation quality, and decreasing the side effects of each drug during elective endoscopic retrograde cholangio-pancreaticography (ERCP).
MATERIALS AND METHODS
Eighty patients aged between 18 and 60 years were distributed randomly into two groups. The dexmedetomidine + propofol group (group DP) received an injection of dexmedetomidine at the dose of 1 mcg/kg in 100 mLsaline, and the propofol group (group P) received plain 100 mL normal saline over 10 min. Subsequently, both groups received a bolus dose of injection propofol 1 mg/kg as sedation, and a modified observer's assessment of alertness/sedation score (MOASS) score was assessed, followed by infusion at the rate of 50 mcg/kg/min during the procedure. A rescue bolus dose (20 mg) of propofol was administered when the patient showed signs of inadequate sedation or analgesia in both groups. Cardiovascular and respiratory parameters were recorded every 10 min throughout the procedure. Post-procedure modified Aldrete score was evaluated for 30 min, and the endoscopist's score was noted at the end of the procedure.
RESULTS
There was a significant difference ( = 0.001) in the additional number of rescue doses of propofol administered in group DP (3.47 ± 0.77) as compared to group P (8.78 ± 1.11). The total dose of propofol was lower in group DP (316.59 ± 43.29 mg) than in group P (443 ± 41.1 mg) with value = 0.001. Statistically significant differences in the hemodynamic values were observed in group DP during infusion ( value < 0.05) of dexmedetomidine and throughout the procedure ( < 0.05) when compared with group P. Endoscopists graded the satisfaction score as very high (3.477 ± 0.77) in group DP.
CONCLUSION
The addition of dexmedetomidine to propofol during ERCP provided better and safer sedation.
背景
丙泊酚是程序性镇静的首选药物。在选择性内镜逆行胰胆管造影术（ERCP）期间，添加α激动剂右美托咪定可能通过提供稳定的血流动力学、更好的镇静质量以及减少每种药物的副作用来改善该手术的安全性。
材料与方法
80名年龄在18至60岁之间的患者被随机分为两组。右美托咪定+丙泊酚组（DP组）接受以1μg/kg的剂量溶于100mL生理盐水中的右美托咪定注射，丙泊酚组（P组）在10分钟内接受100mL普通生理盐水。随后，两组均接受1mg/kg的丙泊酚注射推注作为镇静，并评估改良的观察者警觉/镇静评分（MOASS），然后在手术过程中以50μg/kg/min的速率输注。当两组患者出现镇静或镇痛不足的迹象时，给予20mg的丙泊酚抢救推注剂量。在整个手术过程中，每10分钟记录一次心血管和呼吸参数。术后30分钟评估改良的Aldrete评分，并在手术结束时记录内镜医师的评分。
结果
与P组（8.78±1.11）相比，DP组（3.47±0.77）给予的丙泊酚抢救剂量的额外数量存在显著差异（P=0.001）。DP组丙泊酚的总剂量（316.59±43.29mg）低于P组（443±41.1mg），P值=0.001。与P组相比，DP组在输注右美托咪定期间（P值<0.05）和整个手术过程中（P<0.05）观察到血流动力学值存在统计学显著差异。内镜医师将DP组的满意度评分评为非常高（3.477±0.77）。
结论
在ERCP期间，丙泊酚中添加右美托咪定可提供更好、更安全的镇静效果。
Zotero 插件