复合静脉麻醉在ERCP检查及治疗中的临床应用

Application of intravenous anesthesia on endoscopic retrograde cholangiopancreatography

目的研究咪唑安定、异丙酚及芬太尼复合静脉麻醉在内镜逆行胰胆管造影（ERCP）检查及治疗中的临床效果。方法120例拟行ERCP患者（ASA-级）,依次静注咪唑安定0.03mg/kg,芬太尼1μg/kg,丙泊酚1.5-2.5mg/kg顺序缓慢分次静脉注射至睫毛反射消失开始操作,以微量泵持续泵入丙泊酚0.1-0.15mg/（kg.min）,检查过程中如有恶心、呛咳、躁动时追加丙泊酚20-30 mg,检查结束前3分钟停药。记录麻醉前、麻醉后（麻醉后1分钟）。检查中（操作开始后10分钟）,检查结束时的BP、HR、RR、SpO2,意识消失时间,停药后的意识恢复时间,定向力恢复时间,观察术中有无恶心呕吐、肢动,术后统计有无术中知晓及麻醉满意度情况。结果麻醉后1分钟BP、SpO2较麻醉前降低,HR减慢,但SpO2仍在92%以上,且于1分钟后自行上升,未出现呼吸暂停现象。12例于检查中出现短暂肢动,追加丙泊酚20-30mg后继续检查,麻醉后不到1分钟意识消失,停药后意识恢复较快,定向力恢复时间也不长,所有患者对麻醉均较满意,无术中知晓及恶心呕吐。结论咪唑安定、异丙酚及芬太尼复合静脉麻醉在ERCP检查中是一种既安全又有效的方法。

Objective To investigate the clinic effect of intravenous anesthesia combining Midazolam, propofol and fentanyl in examination and therapy with endoscopic retrograde cholangiopancreatography （ERCP）. Methods Before operation, 60 cases in ASA I level to II level were slowly injected with midazolam, followed by fentanyl and propofol. Operation began when lash reflex disappeared. Then propofol was continuously pumped by micropump. If any nausea, vomit, bucking or restlessness occurred, propofol would be added. Anesthetic was withdrew 3 min before examination end. BP, HR, RR, SpO2, unconscious beginning, conscious recovery time and orientation recovery time were recorded before anesthesia, 1 min after anesthesia, 10 min after operation or examination end. Nausea, vomit and limb-action were monitored during operation. Results BP, SpO2, HR and RR at lmin after anesthesia were lower than that before anesthesia （P〈0.05）, whereas these parameters at other time showed no significant difference from that before anesthesia. 92% of BR in the patient was decreased 1-2 min after anesthesia in 17 cases, without apnea. No surgical consciousness, nausea and vomiting were observed. Conclusion Intravenous anesthesia combining midazolam, propofol and fentanyl is safe and effective in ERCP examination.