小剂量氯胺酮用于高龄患者内镜引导下逆行胰胆管造影术麻醉效果的观察

Observation on the effects of low dose ketamine combined with other intravenous anesthetics for the elderly patients undergoning ERCP

目的观察小剂量氯胺酮和其它静脉麻醉药伍用对高龄(80岁以上)患者内镜引导下逆行胰胆管造影术(ERCP)诊疗过程中麻醉效果的影响。方法选择山西省煤炭中心医院消化内科2016年1月至2017年1月拟行ERCP治疗的高龄患者50例,年龄85~96岁,ASA分级Ⅱ或Ⅲ级,按就诊顺序将其随机分为对照组(C组),氯胺酮组(K组)两组(n=25)。两组均在麻醉诱导时给予咪达唑仑0.01 mg/kg,舒芬太尼0.1μg/kg,进镜前缓慢推注丙泊酚0~50 mg,直到没有抬头和躲避动作,术中维持泵入丙泊酚3~5 mg·kg^(-1)·h^(-1)。K组和C组不同之处,是在诱导时推注丙泊酚前,给予小剂量的氯胺酮0.1 mg/kg。记录两组丙泊酚的用量、呛咳和体动反应发生情况;记录术中发生低氧血症、低血压和血管活性药物的使用情况;记录苏醒时间和术后的不良反应。结果与C组比较,K组诱导时需要推注的丙泊酚量少,体动和呛咳反应发生率低,血压和心率几乎没有下降(P<0.05)。两组患者治疗后均无痛苦体验,且苏醒快、清醒程度高(P>0.05)。结论小剂量氯胺酮联合咪唑、舒芬太尼和丙泊酚,用于高龄患者ERCP的麻醉,呼吸循环系统平稳,安全有效。

ObjectiveTo observe the effects of low dose ketamine combined with other intravenous anesthetics for elderly patients undergoing endoscopic retrograde cholangiopancreatography(ERCP).MethodsFifty elderly patients undergoing ERCP treatment were selected,from January2016to January2017in Shanxi Province Coal Center Hospital,aged85\|96years old and ASA gradeⅡorⅢ.They were randomly divided into2groups(n=25).control group(C group),and ketamine group(K group).The two groups were in the induction of anesthesia with midazolam0.01mg/kg,sufentanil0.1μg/kg,and the slow infusion of propofol0\|50mg before the entering of gastroscopy,until there is no looking up and avoiding movements.And the maintenance of anesthesia was under the infusion of propofol3\|5mg·kg-1·h-1.The difference between the K group and the C group is that small doses of ketamine0.1mg/kg are given before the induction of propofol.The dosage of propofol,cough and body reaction were recorded in two groups.The hypoxemia,hypotension and vasoactive drugs used were recorded,and the recovery time and postoperative adverse reactions were recorded too.ResultsCompared with group C,the K group needed less propofol,had less body motion and cough,and had little decline of blood pressure or heart rate(P<0.05).The two groups had no pain experience after treatment,and they recovered quickly and had a high degree of sobriety(P>0.05).ConclusionLow dose ketamine combined with midazolam,sufentanil and propofol is safe and effective for the anesthesia of ERCP in elderly patients with stable respiratory and circulatory system.