盐酸羟考酮联合丙泊酚对内镜下逆行胰胆管造影术老年患者血流动力学及免疫功能的影响

Effect of Oxycodone Hydrochloride Combined with Propofol on Hemodynamics and Immune Function in Elderly Patients Undergoing Endoscopic Retrograde Cholangiopancreatography

目的探讨盐酸羟考酮联合丙泊酚对内镜下逆行胰胆管造影术(ERCP)老年患者血流动力学及免疫功能的影响。方法选取医院2016年1月至2018年5月收治拟行ERCP的老年患者98例,根据随机数字表法分为对照组和研究组,各49例。术中麻醉对照组给予丙泊酚,研究组给予盐酸羟考酮联合丙泊酚。结果组内比较,两组患者不同时间点脉搏血氧饱和度(SpO2)比较无明显差异(P>0.05);与术前(T1)比较,两组患者给药5min后(T2)至术后苏醒时(T6)平均动脉压(MAP)均降低(P<0.05);与T1比较,对照组患者术中(T4)至退出内镜时(T5)、研究组T5心率(HR)均降低(P<0.05);组间比较,两组T1~T6MAP,HR,SpO2比较无明显差异(P>0.05)。两组患者术后1dT淋巴细胞亚群(CD4+和CD4+/CD8+)水平均较术前降低,但研究组显著高于对照组(P<0.05);两组患者CD8+较术前升高,研究组显著低于对照组(P<0.05);两组患者术后1d白细胞介素10(IL-10)水平降低,研究组显著高于对照组(P<0.05);γ干扰素(IFN-γ)水平升高,研究组显著低于对照组(P<0.05)。两组患者术中不良反应发生率比较无明显差异(P>0.05)。结论盐酸羟考酮联合丙泊酚麻醉方式,可维持行ERCP术式老年患者的血流动力学稳定,缓解其围术期免疫功能紊乱,值得临床推广。

Objective To investigate the effect of oxycodone hydrochloride combined with propofol on hemodynamics and immune function in elderly patients undergoing endoscopic retrograde cholangiopancreatography( ERCP). Methods Totally 98 elderly patients underwent ERCP admitted to our hospital from January 2016 to May 2018 were selected and divided into the control group and the study group according to the random number table method,49 cases in each group. During anesthesia,the patients in the control group were given propofol,while the patients in the study group were given oxycodone hydrochloride combined with propofol. Results There was no significant difference in pulse oxygen saturation( SpO2) between the two groups at different time points( P > 0. 05). Compared with that at the time point before operation( T1),the mean arterial pressure( MAP) in the two groups decreased from 5 min after administration( T2)to the time of postoperative recovery( T6,P < 0. 05). Compared with that at T1,the heart rate( HR) decreased in the control group from intraoperation( T4) to endoscopy withdrawal( T5) and in the study group at T5( P < 0. 05). There was no significant difference in MAP,HR and SpO2 between the two groups at T1-T6( P > 0. 05). On the 1 st day after the operation,the levels of T lymphocyte subsets( CD4+and CD4+/CD8+)in the two groups were lower than those before the operation,but those in the study group were significantly higher than those in the control group( P < 0. 05). However,the level of CD8+in the two groups was higher than that before the operation,but that in the study group was significantly lower than that in the control group( P < 0. 05). On the 1 st day after the operation,the level of interleukin-10( IL-10) in the two groups was lower than that before the operation,but that in the study group was significantly higher than that in the control group( P < 0. 05). However,the level of interferon-γ( IFN-γ) in the two groups was higher than that before the operation,but that in the study group was significantly lower than that in the control group( P < 0. 05). There was no difference in the incidence of adverse reactions between the two groups( P > 0. 05). Conclusion Oxycodone hydrochloride combined with propofol for elderly patients undergoing ERCP can maintain hemodynamic stability and alleviate perioperative immune function,which is worthy of clinical promotion.