观察经鼻右美托咪定应用于老年患者无痛肠镜检查的安全性和有效性。

选取2018年11月至2020年5月常州市第二人民医院120例行无痛肠镜检查的老年患者作为研究对象，随机分为对照组（C组）、低剂量右美托咪定组（D₁组）、中剂量右美托咪定组（D₂组）和高剂量右美托咪定组（D₃组），每组30例。患者常规心电监护后，C组予1.5 ml 0.9%氯化钠溶液滴鼻，D₁、D₂、D₃组分别经鼻予右美托咪定1.0、1.5和2.0 μg/kg，15 min后静脉推注丙泊酚1.5 mg/kg进行麻醉诱导，患者入睡后即行肠镜检查，术中出现体动、睁眼、呛咳等反应时追加丙泊酚0.5 mg/kg；观察记录患者在滴鼻右美托咪定前（T₀）、经鼻滴入右美托咪定10 min（T₁）、静脉给予丙泊酚后进镜时（T₂）、进镜到脾曲时（T₃）、退镜后（T₄）的平均动脉血压（MAP）、心率（HR）、血氧饱和度（SpO₂）、双频谱指数（BIS）值和丙泊酚用药总量；记录苏醒时间、Ramsay镇静评分和不良反应。

（1）组内比较：T₁-T₄时四组MAP、HR、BIS值均较同组T₀时不同程度降低（均P<0.05）；T₁、T₂时C组SpO₂水平较同组T₀时明显降低（P<0.05），D₁、D₂、D₃组的组内各时间点SpO₂水平变化未见显著差异。（2）组间比较：T₀时四组患者MAP、HR、SpO₂、BIS值组间差异均无统计学意义；T₁-T₄时四组间MAP、HR、SpO₂、BIS值水平变化差异均有统计学意义（F=5.323~49.369，均P<0.01）。（3）组间两两比较：T₁-T₄时，D₃组HR明显低于其他三组（P<0.05）；T₂-T₄时，D₁、D₂、D₃组MAP均显著低于C组（P<0.05），D₂组变化幅度最小；T₁和T₃时D₁、D₂、D₃组BIS值均低于C组，T₂和T₄时BIS值均高于C组（P<0.05），D₃组变化幅度最显著；T₁-T₄时，D₂、D₃组SpO₂均明显高于C组（P<0.05），D₃组变化幅度最显著。四组患者丙泊酚用量（F=28.922，P<0.001）、苏醒时间（H=24.452，P<0.001）、镇静评分（Z=113.500，P<0.001）组间差异均有统计学意义；D₂、D₃组丙泊酚用量、苏醒时间、镇静评分明显优于C组（P<0.05）。C组低血压发生率高于其他三组，D₃组心动过缓发生率高于其他三组（P<0.05），D₂组整体疗效优于D₃组。

对于行无痛肠镜检查术的老年患者，与单纯静脉应用丙泊酚相比，术前15 min联合使用1.5 μg/kg中剂量右美托咪定经鼻给药，麻醉镇静效果更好，患者血流动力学更稳定，且操作简单、不良反应发生率低，为一种安全理想的麻醉方案，值得在临床中推广和应用。

To observe the safety and effectiveness of transnasal administration of dexmedetomidine (DEX) in elderly patients undergoing painless colonoscopy.

120 elderly patients who underwent painless colonoscopy in Changzhou Second People’ s Hospital from November 2018 to May 2020 were selected as the research objects. They were randomly divided into control group (group C), low-dose DEX (group D₁), medium-dose DEX (group D₂) and high-dose DEX (group D₃), with 30 cases in each group. After routine ECG monitoring, intranasal administration of 1.5 ml saline for the patients in group C, while intranasal administration of 1.0, 1.5 and 2.0 μg/kg DEX respectively for the patients in group D₁, D₂, D₃. Enteroscopy could be performed after 1.5 mg/kg propofol was administrated, and 0.5 mg/kgpropofol was supplement for somatic reaction, such as body movement, eye opening, and coughing. The mean arterial blood pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO₂) before the intranasal administration of DEX (T₀), 15 min after intranasal administration of DEX (T₁), just the time of the endoscopy (T₂), just the time of splenic flexure (T₃), and record the BIS value and total amount of propofol medication after withdrawal (T₄) were observed. Recovery time, the number of somatic reactions and adverse reactions (vomit, hypotension and bradycardia) were recorded.

(1) Comparison within groups: MAP, HR and BIS values in four groups at T₁-T₄ were lower than those at T₀ (all P<0.05); The SpO₂ level in group C at T₁-T₂ was significantly lower than that in the same group at T₀ (P<0.05), and no significant difference was found in the SpO₂ level in group D₁, D₂ and D₃ at each time point. (2) Comparison among groups: At T₀, there were no significant differences in MAP, HR, SpO₂ and BIS values among the four groups. At T₁-T₄, there were statistically significant differences in MAP, HR, SpO₂ and BIS values among the four groups (F=5.323-49.369, all P<0.01). (3) Pairwise comparison among groups: at T₁-T₄, HR in D₃ group was significantly lower than that in the other three groups (P<0.05). At T₂-T₄, MAP in group D₁, D₂ and D₃ was significantly lower than that in group C (P<0.05), and the change range of group D₂ was the least; BIS values in group D₁, D₂ and D₃ were lower than those in group C at T₁ and T₃, and BIS values at T₂ and T₄ were higher than those in group C (P<0.05), with the most significant change in group D₃. During T₁-T₄, SpO₂ in group D₂ and D₃ was significantly higher than that in group C (P<0.05), and the change range in group D₃ was the most significant. There were significant differences in the amount of propofol (F=28.922, P<0.001), time of recovery (H=24.452, P<0.001) and sedation score (Z=113.500, P<0.001) among the four groups. The dosage of propofol, recovery time and sedation score in group D₂ and D₃ were significantly better than those in group C (P<0.05). The incidence of hypotension in group C was higher than that in the other three groups, and the incidence of bradycardia in group D₃ was higher than that in the other three groups (P<0.05). The overall efficacy of group D₂ was better than that of group D₃.

For elderly patients with painless colonoscopy examination, compared with the simple intravenous application of propofol, preoperative15 min in the combination of 1.5 μg/kg dose DEX by nasal drug delivery, sedative effect is better, more stable hemodynamics in patients with simple operation, low incidence of adverse reactions, as a safe and ideal anesthetic scheme, is worth of popularization and application in clinical.