丙泊酚与依托咪酯靶控输注复合瑞芬太尼用于ERCP的安全性和有效性比较

Comparison of Safety and Efficacy of Propofol and Etomidate Target-Controlled Infusion with Remifentanil in ERCP

目的比较丙泊酚与依托咪酯靶控输注复合瑞芬太尼在经内镜逆行胰胆管造影术(ERCP)中的安全性和有效性。方法选择2018年8—10月在哈尔滨医科大学附属第一医院进行ERCP、美国麻醉医师协会分级Ⅰ~Ⅲ级的80例患者为研究对象,采用随机数字法分为丙泊酚组和依托咪酯组,每组40例。丙泊酚组使用丙泊酚靶控输注2.0μg/mL诱导,依托咪酯组使用依托咪酯靶控输注0.5μg/mL诱导。两组均以脑电双频指数(BIS)值为60调整剂量维持,两组均复合瑞芬太尼靶控输注2.0 ng/mL,右美托咪定持续输注0.5μg/(kg·h),维持BIS 60左右。比较两组患者程序相关时间数值,测量并记录基线值(T 0)、诱导前(T 1)、BIS 60(T 2)、进镜时刻(T 3)、进镜后3 min(T 4)、进镜后6 min(T 5)的平均动脉压、心率、脉搏血氧饱和度、BIS,以及术后不良反应发生情况。结果依托咪酯组睫毛反射恢复时间和离开恢复室时间均长于丙泊酚组[(7.2±3.8)min比(4.5±2.0)min,(11.5±3.8)min比(8.9±2.5)min](P<0.01)。丙泊酚组T 2~T 5的平均动脉压呈下降趋势,依托咪酯组波动范围较少,依托咪酯组T 2~T 5平均动脉压均高于丙泊酚组(P<0.01);依托咪酯组心率在T 4高于丙泊酚组,丙泊酚组T 2~T 5的心率呈下降趋势(P<0.01);丙泊酚组T 2~T 5的脉搏血氧饱和度呈下降趋势,依托咪酯组波动范围较少,依托咪酯组T 4、T 5脉搏血氧饱和度高于丙泊酚组,两组间、时点间、组间和时点间交互作用差异有统计学意义(P<0.01)。依托咪酯组辅助通气、低血压发生率低于丙泊酚组[2.5%(1/40)比22.5%(9/40),0比15.0%(6/40)](P<0.05)。结论与丙泊酚相比,依托咪酯用于ERCP,血流动力学更稳定,术后不良反应更少,安全有效。

Objective To compare the safety and efficacy of both etomidate and propofol in endoscopic retrograde cholangiopancreatography(ERCP).Methods Eighty patients of American Society of Anesthesiologists GradeⅠtoⅢwho underwent ECRP at the First Affiliated Hospital of Harbin Medical University from Aug.to Oct.2018 were included in the study.The patients were randomly assigned to an etomidate group and a propofol group by random number table method,40 cases in each group.The etomidate group was induced with a target-controlled infusion(TCI)of 0.5μg/mL of etomidate.The propofol group was induced with propofol TCI 2.0μg/mL.Both groups were maintained at adjusted doses of bispectral index(BIS)60,and were combined with remifentanil TCI 2.0 ng/mL,dexmedetomidine continuously infused with 0.5μg/(kg·h)to maintain the BIS at around 60.The procedural related time and data of the two groups were compared,testing and recording the mean arterial pressure,heart rate,pulse oxygen saturation and BIS of the baseline(T 0)before induction(T 1),BIS 60(T 2),time of entry(T 3),3 min(T 4),6 min(T 5)after induction,and the occurrence of postoperative adverse reactions.Results The eyelash reflex recovery time and the time of leaving the recovery room of the etomidate group were longer than those of the propofol group[(7.2±3.8)min vs(4.5±2.0)min,(11.5±3.8)min vs(8.9±2.5)min](P<0.01).The mean arterial pressure in the propofol group T 2-T 5 was in down trend,while less waving was seen in the etomidate group,the mean arterial pressure T 2-T 5 in the etomidate group was higher than that in the propofol group(P<0.01).The heart rate of the etomidate group was higher than that of propofol group at T 4,and the heart rate of the propofol group T 2-T 5 was in a down trend(P<0.01).The pulse blood oxygen saturation in the propofol group T 2-T 5 was in a down trend,while less fluctuationwas seen in the etomidate group,and the pulse oxygen saturation of the etomidate group T 4 and T 5 were higher than those of the propofol group,difference between groups,time points and interactions of group and time point were statistically significant(P<0.01).The incidences of assisted ventilation and hypotension in the etomidate group were lower than those in the propofol group[2.5%(1/40)vs 22.5%(9/40),0 vs 15.0%(6/40)](P<0.05).Conclusion Compared with propofol,etomidate used in ERCP is characterized with more stable hemodynamics and fewer postoperative adverse reactions,which can be defined as safe and effective.