氯胺酮联合右美托咪定在ERCP手术中的应用

The application of ketamine combined dexmedetomidine in ERCP operation

目的观察氯胺酮联合右美托咪定在内镜下逆行胰胆管造影术(ERCP)麻醉中的安全性及有效性。方法选择2013—2016年在本院接受ERCP手术患者120例,按随机数字表法分为P组(氯胺酮联合丙泊酚组)和D组(氯胺酮联合右美托咪定组),每组60例。观察术中体动反应、呼吸抑制、心动过缓、低血压、术后恶心呕吐、术后谵妄及苏醒延迟的发生情况,记录入室(T_0)、诱导后(T_1)、进镜(T_2)、切开Oddis括约肌(T_3)、术中(T_4)和术毕(T_5)时的生命体征,记录氯胺酮用量、手术时间和苏醒时间。结果 P组与D组的术中体动反应发生率和苏醒时间无明显差异(P>0.05),P组T1、T2、T3、T4和T5的呼吸频率明显低于D组(P<0.05)。结论氯胺酮联合右美托咪定的麻醉方式可安全和有效地应用于ERCP手术,在术中呼吸管理方面更具有优势。

Objective To observe the safety and efficacy of ketamine combined with propofol or dexmedetomidine in endoscopic retrograde cholangiopancreatography（ERCP）operation.Methods120 patients received ERCP surgery in our hospital during 2013 and 2016 were randomly divided into P group（ketamine combined with propofol group）and D group（ketamine combined with dexmedetomidine group）,60 cases in each group.The intraoperative body movement,respiratory depression,bradycardia,postoperative nausea and vomiting,delirium and delayed recovery were observed.The vital signs of the patients were recorded at the following time points：before induction（T0）,after induction（T1）,endoscopic insertion（T2）,incision of sphincter of Oddis（T3）and intraoperative（T4）and postoperative（T5）.The amount of ketamine,the operation time and analepsia time was also recorded.Results There were no significant difference between P group and D group in intraoperative body movement rate and the recovery time（P〈0.05）.The intraoperative RR of P group decreased significantly compared with D group at all the five time points（P〈0.05）.ConclusionsKetamine combined with dexmedetomidine can is safe and effective in ERCP operation and has more advantages in respiratory management.