右美托咪定和氟比洛芬酯预处理后靶控输注丙泊酚行内镜逆行胰胆管造影手术麻醉的临床研究

Clinic application of target controlled infusion of propofol after pretreatment with dexmedetomidine and flurbiprofen axetil injection during ERCP

目的比较右美托咪定、氟比洛芬酯（凯纷）预处理在靶控输注（TCI）丙泊酚内镜逆行胰胆管造影（ERCP）手术麻醉中的临床效应。方法随机将患者分为两组：右美托咪定组（D组,30例）和对照组（C组,20例）。D组按0.5μg/kg右美托咪定＋凯纷50 mg稀释成20 ml泵注10 min,C组单纯给凯纷50 mg稀释成20 ml泵注10 min。靶控输注丙泊酚以3.5μg/ml的浓度开始诱导,以0.3μg/ml递增,直到脑电双频指数（BIS）达60以下。插镜完成后降低丙泊酚TCI浓度0.5μg/ml维持麻醉,术中当BIS〈40时,则递减丙泊酚浓度0.3μg/ml,维持BIS值40~60,直至退镜停止丙泊酚注射。结果两组患者术前、诱导后、术中及苏醒后的Sp O2均无统计学差异（P〉0.05）。D组经预处理后（T1）比C组HR明显减慢[（77.9±13.6）次/min vs.（86.8±9.2）次/min,P=0.03],丙泊酚诱导最高靶浓度及丙泊酚诱导剂量,在D组小于C组[（3.93±0.43）μg/ml vs.（4.35±0.59）μg/ml,P=0.014;（11.20±2.54）ml vs.（14.01±4.10）ml,P=0.027],两组手术时间及丙泊酚手术总用量无明显差别,两组术中各时点血压无统计学差异,患者苏醒（OAA/S≥4分）时的BIS值D组高于C组,而时间长于C组[74.09±9.96 vs.66.67±6.67,P=0.011;（14.29±7.69）min vs.（9.10±2.95）min,P=0.018]。结论右美托咪定、凯纷预处理后丙泊酚靶控输注给药,能很好完成内镜逆行胰胆管造影术患者的麻醉,丙泊酚诱导剂量更小。全部患者无呼吸抑制,循环功能稳定。但BIS〈60作为插镜指标有待进一步探讨。

Objective To compare the clinical efficacy of target controlled infusion of propofol after pretreatment with dexmedetomidine and flurbiprofen axetil injection during ERCP. Methods 50 patients scheduled for ERCP were randomly assigned to two groups： dexmedetomidine group （Group D, n=30） and control group （Group C, n=20）. Group D received Dex 0.8 μg/kg and flurbiprofen axetil 50 mg intravenous injection for 10 min. And Group C received flurbiprofen axetil 50 mg intravenous injection for 10 min. In two groups anaesthesia was induced with target-controlled infusion of propofol with target concentration 3.5 μg/ml and increased in increment of 0.3 μg/ml until the BIS value was lower than 60. After insertion of the endoscope the target concentration of propofol was decreased in decrement of 0.5 μg/ml to maintain anaesthesia. And if the BIS value was lower than 40, the target concentration of propofol was decreased in decrement of 0.3 μg/ml to maintain the BIS value between 40 to 60 until the exit of endoscope. Results There was no significant difference in SpO2 of the two groups before surgery, after induction, during surgery and after awakening （P〉0.05）. In Group D, HR had a significant decrease at T1 than those in Group C, （77.9±13.6）beat/min, （86.8±9.2）beat/min, P=0.03. The maximum induction concentration and the induction dose of propofol in Group D were much less than in Group C [（3.93±0.43）μg/ml, （4.35±0.59）μg/ml, P=0.014; （11.20±2.54）ml, （14.01±4.10）ml, P=0.027]. There was no significant difference in surgery time and the dose of propofol of both groups. BP had no significant difference at each time point in both groups. In Group D the BIS value on awakening was higher and the patients needed a longer recovery time than those in Group C [74.09±9.9, 66.67±6.67, P=0.011; （14.29±7.69）min, （9.10±2.95）min, P=0.018]. Conclusions Target controlled infusion of propofol after pretreatment with dexmedetomidine and flurbiprofen axetil injection shows good results for ERCP with reducing induction dose of propofol, no respiratory depression and stable circulation. But it needs to be further explored that the timing of the insertion is the BIS value is lower than 60.