丙泊酚复合瑞芬太尼和右美托咪定静脉麻醉在内镜逆行胰胆管造影中的应用

Evaluation of intravenous anesthesia with propofol combined with remifentanil and dexmedetomidine for endoscopic retrograde cholangiopancreatography

目的观察丙泊酚复合瑞芬太尼和右美托咪定静脉麻醉在内镜逆行胰胆管造影术（ERCP）中的疗效及安全性。方法拟行ERCP患者70例,按是否自愿接受静脉麻醉分为两组：静脉麻醉组（研究组）38例和常规组（对照组）32例。研究组以舒芬太尼3~5μg、丙泊酚1~2 mg/kg静注诱导,待患者入睡,取丙泊酚200 mg＋瑞芬太尼300μg＋右美托咪定20μg稀释至50 ml泵注,泵速为患者体质量（kg）的2/3毫升数（ml）,3~5 min平稳后减降至体质量（kg）的1/2毫升数（ml）维持;对照组为东莨菪碱0.3 mg＋哌替啶50 mg＋地西泮5~10 mg术前30 min肌注。监测并记录诱导时间、手术时间、苏醒时间（给药至呼之睁眼时间）和苏醒质量,记录术前（T0）、内镜过咽喉部（T1）、进入或切开oddis括约肌（T2）和术毕（T3）4个时点的MAP,HR,Sp O2与体动变化,以及呛咳、恶心呕吐等不良反应。结果研究组诱导时间为（63±14）s,苏醒时间为（127±19）s;苏醒质量：优29例（76.3%）,良9例（23.7%）。对照组均清醒。与术前比较,研究组在T1、T2、T3各时点HR、MAP无明显变化（P〉0.05）,而对照组各时点HR和MAP均有明显增高（P〈0.05）,两组间比较,差异有统计学意义（P〈0.01）。两组Sp O2相比无差异。麻醉效果评定：研究组Ⅰ、Ⅱ级明显多于对照组,而不良反应发生率明显少于对照组（P〈0.05）。结论丙泊酚复合瑞芬太尼和右美托咪定静脉麻醉可安全地在ERCP中应用,麻醉效果好,不良反应少。

Objective To observe the effect and safety of intravenous anesthesia with propofol plus remifentanil and dexmedetomidine during the process of endoscopic retrograde cholangiopancreatography（ ERCP）. Methods Seventy patients,who would undergo ERCP,were divided into intravenous anesthesia group（ trial group） and routine group（ control group） according to whether the voluntary acceptance of intravenous anesthesia or not. The trial group received intravenous anesthesia with sufentanil（ 3 to 5μg /kg） and propofol（ 1 to 2 mg /kg） for induction,and when the patients fall into sleep,propofol（ 200 mg）,remifentanil（ 300μg） and dexmedetomidine（ 20μg） were added to 50 ml of solution,which were pumped in at the speed of 2 /3 of the body mass number（ ml / h） for 3 to 5 minutes and then the speed was decreased down to 1 /2 of the body mass for maintenance. The control group was intramuscularly anaesthetized with scopolamine（ 0. 3 mg）,pethidine（ 50 mg） and diazepam（ 5 to 10 mg） before operation. Mean arterial pressure（ MAP）,heart rate（ HR）,pulse oxygen saturation（ Sp O2） and changes in body movement were monitored and recorded at the time of preoperation（ T0）,endoscopy passing through throat（ T1）,incision of sphincter of Oddis（ T2）and closure of surgery（ T3）. Induction time,operation time,recovery from anesthesia,adverse reactions including cough,nausea and vomiting were recorded. The awakening quality was assessed. Results In the trial group,the induction time was（ 63 ± 14） s,and the time of recovery from anesthesia was（ 127 ± 19） s. The awakening quality was excellent in 76. 3% and good in 23. 7%,yet the control group was all awake. Compared with preoperation,the trial group had no significant changes in HR and MAP at T1,T2 and T3（ P〈0. 05）,while the control group had significant increases in HR and MAP（ P〈0. 05）,and there were significant differences between the two groups（ P〈0. 01） at the same time. However,the Sp O2 of the two groups was of no significant difference（ P〈0. 05）. As for anesthesia assessment,the number of level Ⅰ and Ⅱ was significantly higher in the trial group than in the control group,while the incidence of adverse reactions was significantly less in the trial group than in the control group（ P〈0. 05）.Conclusion The intravenous anesthesia with propofol combined with remifentanil and dexmedetomidine is safe during the process of ERCP,and it has better anesthesia quality and less adverse reaction.