| 贺腾,陈云华,黄益波,等.丙泊酚联合右美托咪定在 OSAHS病人 DISE检查中的应用[J].安徽医药,2025,29(7):1462-1466. |
| 丙泊酚联合右美托咪定在 OSAHS病人 DISE检查中的应用 |
| Application of propofol combined with dexmedetomidine in the examination of DISE in OSAHS patients |
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| DOI：10.3969/j.issn.1009-6469.2025.07.040 |
| 中文关键词: 麻醉，静脉 睡眠呼吸暂停，阻塞性 药物诱导睡眠内镜(DISE) 丙泊酚 右美托咪定 不良反应 |
| 英文关键词: Anesthesia,intravenous Sleep apnea,obstructive Drug induced sleep endoscopy(DISE) Propofol Dexmedetomi-dine Adverse reactions |
| 基金项目:常熟市科研计划项目( cswsq201601) |
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| 中文摘要: |
| 目的观察将丙泊酚联合右美托咪定联合应用于阻塞型睡眠呼吸暂停低通气综合征( OSAHS)病人药物诱导睡眠内镜(DISE)检查中病人整体获益情况，指导临床相关检查选取最佳麻醉方案。方法选取 2019年 10月至 2021年 7月南通大学附属常熟医院接收 80例 OSAHS病人为研究对象，该研究为前瞻性研究，根据病人选取的麻醉诱导药物不同将其分为对照组( 40例，丙泊酚)观察组( 40例，丙泊酚 +右美托咪定)对比两组病人不同时点血流动力学［分别于入室时( T1)、麻醉诱导后( T2)、查开始 5 min(T3)、检查结束时( T4)，观察并记录病，人血氧饱和度( SpO2)、平均动脉压( MAP)、心率］、警觉 /镇静评分( OAA/S)检［于镇静 5 min、10 min时评估病人 OAA/S评分］、检查相关情况［丙泊酚总用量、镜检时长、苏醒时间］、简易精神状态评分量表评分( MMSE)［检查前、病人苏醒时］及不良反应。结果两组 MAP、心率、 SpO2指标的整体组间差异、组内差异及交互作用，均差异有统计学意义( P<0.05)。两组 MAP、心率、 SpO2变化趋势不同，且观察组的 T1、T2、T3、T4时间点的 MAP各时间点［(66.32±6.12)mmHg、(68.44±6.09)mmHg(72.23±4.46)mmHg、(76.34±4.53)mmHg］均低于对照组的 MAP［(90.11±8.50)mmHg、(70.50±6.10)mmHg、(74.84±4.12)mmHg、(78.57±8.94)mmHg］，均差异有统计学意义( P<0.05)；观察组 T1、T2、T3时间点的心率［( 71.53±10.10)次 /分、(72.69±6.33)次 /分、(72.17±8.10)次 /分］均低于对照组的心率［( 72.32±7.58)次 /分、(73.13±8.50)次 /分、(73.20±6.52)次 /分］，均差异有统计学意义( P<0.05)；观察组 T1、 T3时间点的 SpO2(97.69±0.82)%、T4T2、 ［( 97.56±0.85)%、(98.62±0.60)%］高于对照组的 SpO2(96.21±0.52)%、(97.10±0.64)%］均差异有统计学意义( P<0.05)；观察组［(95.18±0.50)%、病人 OAA/S评分镇静 5 min(2.51±0.45)分、镇静 10 min(1.25±0.41)分，均低于对照组病人，镇静 5 min(3.85±0.75)分、镇静 10 min(2.12±0.62)分( P<0.05)；观察组丙泊酚总用量(75.12±5.25)mg少于对照组丙泊酚总用量(102.12±10.12)mg，且观察组苏醒时间(3.56±1.01)min短于对照组苏醒时间( 6.52±1.68)min(P<0.05)；病人苏醒时，观察组 MMSE评分( 24.52±2.05)分高于对照组 MMSE评分( 23.02±1.85)分( P<0.05)；两组病人不良反应总发生率对比，差异无统计学意义( P>0.05)。结论 OSAHS病人 DISE检查中采用右美托咪定联合丙泊酚麻醉时，病人血流动力学较稳定，警觉镇静状态理想，苏醒时病人精神状态评分恢复较快，病人整体获益情况良好，且安全性较好。 |
| 英文摘要: |
| Objective To observe the application of propofol combined with dexmedetomidine in drug-induced sleep endoscopy(DISE) for patients with obstructive sleep apnea hypopnea syndrome (OSAHS), and to evaluate the overall benefits to patients in orderto guide the selection of the optimal anesthesia regimen for clinical examinations.Methods The study was a prospective study. A totalof 80 OSAHS patients admitted to Affiliated Changshu Hospital of Nantong University from October 2019 to July 2021 were selected asstudy objects, and assigned into a control group (40 patients, propofol) and an observation group (40 patients, propofol + dexmedetomi-dine) according to different anesthesia induction drugs selected by the patients. The hemodynamics of the two groups were compared atdifferent time points [at the time of entry (T1), after induction of anesthesia (T2), 5 min after the beginning of examination (T3), and atthe end of examination (T4), respectively]. Blood oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), alertness/se-dation score (OAA/S) [OAA/S score was evaluated at 5 min and 10 min of sedation] were observed and recorded. Meanwhile, relevantconditions [total propofol dosage, duration of microscopy, time to recovery], and Mini-Mental State Examination (MMSE) [before exami-nation, upon patient awakening] and adverse reactions were assessed.Results The differences in MAP, heart rate, and SpO. between the two groups were statistically significant in terms of overall group differences, within-group differences, and interaction effects (P< 0.05). The trends of changes in MAP, heart rate, and SpO. were different between the two groups. The MAP values at T1, T2, T3, andT4 time points in the observation group [(66.32±6.12) mmHg, (68.44±6.09) mmHg, (72.23±4.46) mmHg, (76.34±4.53) mmHg] were alllower than those in the control group [(90.11±8.50) mmHg, (70.50±6.10) mmHg, (74.84±4.12) mmHg, (78.57±8.94) mmHg], with statis-tically significant differences (P<0.05). The heart rates at T1, T2, and T3 time points in the observation group [(71.53±10.10) beats/min, (72.69±6.33) beats/min, (72.17±8.10) beats/min] were all lower than those in the control group [(72.32±7.58) beats/min, (73.13±8.50) beats/min, (73.20±6.52) beats/min], with statistically significant differences (P<0.05). The SpO . values at T1, T2, and T3 timepoints in the observation group [(97.56±0.85) %, (97.69±0.82) %, (98.62±0.60) %] were higher than those in the control group [(96.21±0.52) %, (95.18±0.50) %, (97.10±0.64) %], with statistically significant differences (P<0.05). The OAA/S scores at 5 min and 10 min ofsedation in the observation group were lower than those in the control group [(2.51±0.45)points vs. (3.85±0.75)points, (1.25±0.41)points vs. (2.12±0.62)points] (P<0.05). The total dose of propofol in the observation group was less than that in the control group [(75.12±5.25) mg vs. (102.12±10.12) mg], and the awakening time in the observation group was shorter than that in the control group [(3.56±1.01) min vs. (6.52±1.68) min] (P<0.05). At awakening, the MMSE score in the observation group was higher than that in the control group [(24.52± 2.05)points vs. (23.02±1.85)points] (P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05).Conclusions When dexmedetomidine combined with propofol is used for anesthesia during DISE inpatients with OSAHS, the patients are more hemodynamically stable, with an ideal level of conscious sedation. The patients demonstraterapid recovery with high mental status scores upon emergence, with favorable overall clinical benefits and acceptable safety. |
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