The Clinical Research Of Demedetomidine Combind With Remifentanil For Painless Colonoscopy

Objective: Using different doses of demedetomidine combind withremifentanil used in painless colonoscopy screening, to explore the feasibilityand the most safe and effective drug concentration and dosage.Methods: Select150ASA grade Ⅰ-Ⅱ level patients,undergoingpainless colonoscopy, ranging in age from19to79. Those patients wererandomly divided into Ⅰ, Ⅱ Ⅲ three groups,50cases in each group. Allpatients with regular line of bowel preparation before inspection. Afterentering the inspection room all patients made left recumbent positions,monitoring systolic blood pressure（SBP）, diastolic blood pressure（DBP）, heartrate （HR）, saturation of blood oxygen （SpO2）, respiratory rate （RR）, the BISindex, etc.Through the vein of upper extremity, Ⅰ group was given DEX0.2ug/kg, Ⅱ group was given DEX0.3ug/kg, Ⅲ group was given DEX0.4ug/kg, three groups were slowly injection within2minutes. Followingthree groups all give loading dose of remifentanil1ug/kg, pumping within2minutes, after thart changed to the maintenance dose of0.1ug/kg/min forpumping, begin the operation after2minutes and stop pumping theremifentanil until the end.Record the SBP, DBP, HR, SP02, RR of the patientsat the time when entering the inspection room （T₀）, to the following DEX（T₁）, began to check （T₂）, check after the first5minutes （T₃）, check after thefirst10minutes （T₄）, at the end of the inspection. Record the BIS values at thetime T₀, T₁, T₂and the lowest BIS values of patients. Assessment the analgesiceffect （excellent, good, poor）, observation the adverse reactions of the patientssuch as nausea, vomiting and bradycardia when and after the examination. Ifthe patient in the HR <50times, given atropine0.5mg. Append50mg ofpropofol when patients felt unbearable. Results:1The situation of three groups of patients: there is no differencebetween the three groups in age, weight and opration time.2Analgesic effect comparison: Ⅰgroup analgesic effect "optimal"group35cases,13cases "good","bad" person in2cases; Ⅱ group analgesiceffect "optimal"44cases,6cases "good","poor" in0; Ⅲ group analgesiceffect "optimal"47cases,3cases "good","poor" in0. Ⅰ group comparedwith Ⅱand Ⅲ group, the difference was statistically significant （P <0.05）; Ⅱgroup compared with Ⅲ group there was no statistically significant difference（P>0.05）.3Adverse reaction:（1） bradycardia （HR <50times/min） cases: Ⅰgroup have no cases,1case in Ⅱ group, Ⅲ group of6cases. Ⅰgroupcompared with Ⅲ group have significant difference （P <0.05）. There was nodifference betweenⅠ group and Ⅱ, Ⅱ group and Ⅲ （P>0.05）.（2） cases ofnausea and vomiting: Ⅰ group1example, Ⅱ group1example, Ⅲ group in2cases, there was no difference in the three groups （P>0.05）.4Systolic blood pressure changes:（1） all time points between threegroups there was no difference in the changes of systolic blood pressure （P>0.05）.（2） within every group, systolic blood pressure at the time point of T₁–T₅were lower than time point of T₀, there was significant difference （P <0.05）. Comparison between T₁, T₂, T₃, T₄, T₅: inⅠgroup, the systolic bloodpressure of T₁, T₃is lower than the T₅, the difference was statisticallysignificant （P <0.05）, and the rest of all indifference（P>0.05）; in Ⅱ group,systolic blood pressure of T₁, T₂, T₃is lower than the T₅, systolic bloodpressure of T₂is lower than the T₄, the difference was statistically significant（P <0.05）, the rest are indifference between each other; in Ⅲ group, systolicblood pressure of T₁is higher than T₂, T₃, T₄, T₅, the systolic blood pressure ofT₂, T₄, T₅is higher than T₃, difference was statistically significant （P <0.05）,there was no difference between T₂, T₄,T₅（P>0.05）.5Diastolic blood pressure changes:（1） the change of diastolic pressurebetween the three groups at all time points was indifference （P>0.05）.⑵comparison within group: inⅠ group, the diastolic pressure of point T₁, T₂, T₃was lower than T₀（P <0.05）, no difference between T₄,T₅and T₀（P>0.05）;in Ⅱ group, the diastolic pressure of point T₁, T₂, T₃was lower than T₀（P <0.05）, no difference between T₄, T₅and T₀（P>0.05）; in Ⅲ group, thediastolic blood pressure of T₁,T₀was indifference （P>0.05）, the diastolicblood of T₂, T₃, T₄, T₅were lower than T₀, T₁（P <0.05）.6Heart rate changes:（1） the changes of heart rate between the threegroups at different time points had no significant difference （P>0.05）.⑵comparison within group: the heart rate of time points of T₁, T₂, T₃, T₄, T₅were lower than T₀in each grou（P <0.05）; withinⅠgroup, the difference ofT₁-T₅was not statistically significant （P>0.05）; in Ⅱ group, there was nodifference between T₁and T₂, the heart rate of T₃, T₄, T₅was increasedcompared with T₁, and indifference between T₃, T₄, T₅（P>0.05）; in Ⅲ group,there was no difference between T₂and T₁（P>0.05）, the heart rate of T₃, T₄,T₅was increased compared with T₁and T₂, comparison between T₃, T₄, T₅was indifference （P>0.05）.7Respiration frequency changes:（1） the changes of respiratoryfrequency of three categories at different time points had no significantdifference （P>0.05）.⑵comparison within group: Ⅰ group: respiratoryfrequency of T₁-T₅were below the T₀, the difference was statisticallysignificant （P <0.05）, T₁-T₅has no statistically significant difference （P>0.05）; Ⅱ group: respiratory frequency of T₁-T₅were below the T₀, respiratoryfrequency of T₂-T₅lower than T₁, the difference was statistically significant （P<0.05）, but there was no difference in the T₂to T₅（P>0.05）; Ⅲ group:respiratory frequency of T₁-T₅were below the T₀, respiratory frequency ofT₂-T₄lower than T₁（P <0.05）, but there was no difference in the T₂to T₅（P>0.05）.8The change of the blood oxygen: saturation between different groupsand different time of blood oxygen saturation changes have no difference （P>0.05）.9BIS value changes:（1） the BIS values of three sets of T₁, T₂werebelow the T₀, the difference was statistically significant （P <0.05）;⑵ comparison between the group: there was no difference at the time points of T₀,T₁and T₂between three groups （P>0.05）, but the lowest BIS value ofgroup Ⅲ is lower than the lowest ofⅠand Ⅱ group, the difference wasstatistically significant （P <0.05）.Conclusions:1Right beauty holds the demedetomidine0.3ug/kg or0.4ug/kgcombind with remifentanil, used for inspection of colonoscopy can obtaingood analgesic effect.2Give us right hold demedetomidine of0.3ug/kg compared to0.4ug/kg, the changes of blood pressure and heart rate was more smoothly,adverse reactions was lighter, so more secure.