不同剂量羟考酮复合丙泊酚靶控输注麻醉在胆总管结石患者内镜治疗中的比较

Comparison of different doses of oxycodone combined with propofol target controlled infusion in patients with choledocholithiasis undergoing endoscopic therapy

目的观察和评价不同剂量羟考酮复合丙泊酚靶控输注在胆总管结石患者行内窥镜逆行胰胆管造影(ERCP)合并内镜下括约肌切开术(EST)中的麻醉效果与不良反应。方法选择2016年1月至2017年3月于我院消化内科行择期ERCP合并EST的患者120例,随机分为4组(n=30),即舒芬太尼对照组(A组)、小剂量羟考酮组(B组)、中剂量羟考酮组(C组)、大剂量羟考酮组(D组)。A组于麻醉诱导前5 min予0.10μg/kg舒芬太尼静注,B、C、D组于麻醉诱导前5 min分别予0.08、0.10、0.12 mg/kg羟考酮静注。所有患者均采用丙泊酚靶控输注麻醉。记录各组患者入室时(T_0)、诱导后(T_1)、进镜时(T_2)、镜入十二指肠乳头开口时(T_3)丙泊酚效应室浓度(Ce)、平均动脉压(MAP)、心率(HR);记录丙泊酚总用量、手术时间、患者苏醒时间;记录术中严重低血压、心动过缓、呼吸抑制、呛咳和体动、以及术后恶心呕吐等麻醉相关不良事件。结果 B组患者T_1~T_3时间点丙泊酚Ce,以及T_2和T_3时间点MAP和HR均高于A、C和D组,差异均有统计学意义(P<0.05);B组患者丙泊酚用量多于A和C组,而D组少于A、B和C组,差异均有统计学意义(P<0.01);D组患者苏醒时间长于A、B和C组,差异均有统计学意义(P<0.01);四组患者不良事件发生率差异均无统计学意义(P>0.05)。结论麻醉诱导前5 min静注0.10 mg/kg羟考酮复合丙泊酚靶控输注在ERCP合并EST中麻醉效果满意,且不延长苏醒时间,不增加麻醉相关不良事件发生率。

Objective To investigate the anesthetic effect and adverse events on different doses of oxyco- done combined with propofol target controlled infusion （TCI） in patients with eholedocholithiasis undergoing endo- scopic retrograde cholangio pancreatography （ERCP） with endoscopic sphincterotomy （EST）. Methods One hun- dred and twenty patients with choledocholithiasis underwent ERCP with EST in Department of Gastroenterology, Fuzhou General Hospital, from January, 2016 to March, 2017 were enrolled in this study. Patients were randomly divided into 4 groups （n = 30 in each group ） including the sufentanil control group （Group A ）, low dose of oxyco- done group （Group B） , moderate dose of oxycodone group （ Group C ） , and high dose of oxycodone group （Group D）. Patients in Group A received 0.10 μg/kg intravenous sufentanil, and patients in Group B, C, and D received 0.08 mg/kg, 0.10 mg/kg, and 0.12 mg/kg intravenous oxycodone, respectively, at 5 min before induction of gener- al anesthesia followed by propofol TCI. Effect of compartment concentration （Ce） of propofol, mean arterial pres- sure （MAP）, and heart rate （HR） at the given time point when patients transferring to operation room （To）, after induction （T,）, endoscope through throat （T2）, and endoscope through major duodenal papilla （T3） were record- ed. The accumulative dose of propofol, duration of operation, and recovery time were also recorded. Intraoperative sever hypotension, bradycardia, respiratory depression, coughing and moving, and postoperative nausea and vom- iting were recorded. Results Propofol Ce at T^-T3 as well as MAP and HR at T2 and T3 in Group B were signifi- cantly higher than those in Group A, C, and D, respectively （P 〈 0.05）. The accumulative dose of propofol in Group B was more than that in Group A and C, while the accumulative dose of propofol in Group D was less than that in Group A, B, and C, respectively （P 〈 0.01）. Recovery time in Group D was longer than that in Group A, B, and C, respectively （P 〈 0.05）. Similar incidences of intraoperative sever hypotension, bradycardia, respiratory depression, coughing and moving, and postoperative nausea and vomiting were also observed. Conclusions 0.10 mg/kg intravenous oxycodone at 5 rain before induction of general anesthesia combined with propofol TCI presents a favorable anesthetic effect in patients with choledocholithiasis undergoing ERCP with EST without a prolonged recovery time and the increased incidence of adverse events.