单独持续输注瑞芬太尼用于经内镜逆行胰胆管造影术清醒镇静的可行性探讨

Feasibility study of continuous remifentanil infusion alone for conscious sedation during endoscopic retrograde cholangio-pancreatography

目的研究单独持续输注瑞芬太尼用于经内镜逆行胰胆管造影术(ERCP)清醒镇静的临床效果和安全性。方法选择49例美国麻醉医师协会Ⅰ～Ⅲ级、年龄39～88岁、在清醒镇静下行ERCP的患者,首先以0.2μg.kg-1.min-1速率持续输注瑞芬太尼5分钟,手术开始后减为0.15μg.kg-1.min-1,未合用其他麻醉药物。观察两组患者麻醉前(T0)、手术开始(T1)、手术开始后5分钟(T2)、手术开始后10分钟(T3)和术毕(T4)时平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、血氧饱和度(SpO2)、脑电双频指数(BIS)以及术后改良Aldrete镇静评分、操作者满意度评分和不良反应发生情况,并记录手术操作时间和麻醉时间。结果与麻醉诱导前基础值T0比较,患者T1、T2、T3和T4时MAP无明显变化;T3、T4时HR均明显升高(P<0.01);T4时SpO2值明显降低(P<0.05);T1、T2、T3和T4时BIS值均明显降低(P<0.01)。所有患者均顺利完成操作,操作过程中有3例患者SpO2降至90%以下,无患者需要面罩辅助通气或气管插管。4例患者在插入十二指肠镜时发生恶心,3例患者在取石操作过程中出现轻微疼痛感,但均可忍受,疼痛评分未超过3分。4例患者对镜干入口和取石操作无记忆,10例患者对镜干入口有记忆,35例患者对两者均有记忆。4例患者在术毕镜干取出时处于睡眠状态,其余患者在术毕时均处于清醒状态;16例患者术后发生恶心、呕吐;操作者满意度评分为97.1±4.2。结论单独持续输注瑞芬太尼用于ERCP实施清醒镇静可获得满意的麻醉效果,且安全性好。

Objective To study the clinical efficacy and safety of remifentanil infusion alone for conscious sedation during endoscopic retrograde cholangio-pancreatography（ERCP）.Methods 49 patients in American Society of Anesthesiologists physical status Ⅰ-Ⅲ,aged 39-88 years old,scheduled for ERCP were infused continuously at a rate of 0.2 μg·kg^-1·min^-1 for 5 min before operation,and decreased to 0.15 μg·kg-1·min-1 after operation,the other drugs were not given.Mean artery pressure（MAP）,heart rate（HR）,respiratory rate（RR）,O2-saturation（SpO2）,bispectral index（BIS） were recorded before anesthetic induction（T0）,at beginning of operation（T1）,5 min after operation（T2）,10 min after operation（T3）and at end of operation（T4）.The Modified Aldrete scores,operator satisfaction scores and side effects were observed after operation,in operation and anesthesia were also recorded.Results As compared with preinduction values,MAP at T2 and T3 were significantly higher,HR at T1,T2,T3 and T4 were significantly higher,SpO2 values at T3,T4 were significantly lower,BIS at T1,T2,T3 and T4 were significantly lower.Uncontrolled agitation and movement during sedation did not occur in either group.SpO2 of 〈90% was observed in three patients,no intubation and face mask ventilation were required.During insertion of duodenoscopy,nausea occurred in four patients,three patients felt slight pain during stone extraction action.Four patients showed forgetfulness to insertion of duodenoscopy and stone extraction action,10 patients remembered the insertion of duodenoscopy,35 patients showed forgetfulness to the above two procedures.Four patients were asleep at the end of operation,the rest patients were awake.The operator satisfaction scores were 97.1±4.2.Conclusion The continuous remifentanil infusion alone for conscious sedation during ERCP showed satisfactory anesthesia effect and safe.