纳布啡复合丙泊酚在60岁以上患者无痛内镜逆行胰胆管造影术中的应用

Application of nalbuphine combined with propofol in painless endoscopic retrograde cholangiopancreatography in patients over age 60

目的探讨纳布啡复合丙泊酚在60岁以上患者无痛内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)中的临床疗效及安全性。方法选择行ERCP的60岁以上患者104例,按随机数字表法分为观察组和对照组(每组52例)。观察组行纳布啡复合丙泊酚麻醉,静脉推注纳布啡0.15 mg/kg;对照组行芬太尼复合丙泊酚麻醉,静脉推注芬太尼1.0μg/kg;两组均于静脉推注5 min后给予丙泊酚1.5 mg/kg诱导,继以丙泊酚3.0~5.0 mg•kg^-1•h^-1维持。记录两组患者一般临床资料,术前(T0)、术中(T1)、术后(T2)血压、心率、呼吸频率(respiratory rate,RR)、SpO2,以及麻醉诱导时间、检查操作时间、麻醉苏醒时间、术中丙泊酚总用量、术中体动次数及不良反应;检测并比较T0及T2时空腹血糖(fasting blood glucose,FBG)、C反应蛋白(C-reactive protein,CRP)、促肾上腺皮质激素(adrenocorticotrophic hormone,ACTH)等应激指标。结果T0、T1、T2时,两组患者血压、心率、RR、SpO2比较差异均无统计学意义(P>0.05);两组患者麻醉诱导时间、检查操作时间、麻醉苏醒时间差异无统计学意义(P>0.05);两组患者T2时FBG、CRP、ACTH均高于T0时(P<0.05)。与对照组比较,观察组术中丙泊酚总用量、不良反应发生率、术中体动次数减少(P<0.05),术后CRP和ACTH水平均降低(P<0.05)。结论纳布啡0.15 mg/kg复合丙泊酚全身麻醉用于60岁以上患者无痛ERCP的临床效果及安全性较芬太尼1.0μg/kg复合丙泊酚更好。

Objective To investigate the clinical efficacy and safety of nalbuphine combined with propofol in patients aged 60 year or older who underwent painless endoscopic retrograde cholangiopancreatography(ERCP).Methods One hundred and four patients aged 60 year or older who underwent ERCP were divided into observation group and control group(n=52),according to the ran‐dom number table method.Patients in observation group were anesthetized with nalbuphine combined with propofol:0.15 mg/kg nalbu‐phine was intravenously injected.Control group was anesthetized with fentanyl combined with propofol:1.0μg/kg fentanyl was intrave‐nously injected.Both groups were given 1.5 mg/kg propofol 5 min after intravenous injection and maintained at 3.0‒5.0 mg·kg−^1 h^−1.The general clinical data of the two groups were recorded.The blood pressure,heart rate,respiratory rate(RR),pulse oxygen saturation(SpO2)were recorded before operation(T0),during operation(T1)and after operation(T2).The induction time of anesthesia,the length of inspection and operation,the anesthesia recovery time,the total dosage of propofol during operation,the number of body movements during opera‐tion and the adverse reactions were recorded.The fasting blood glucose(FBG),C reactive protein(CRP),adrenocortical hormone(ACTH)before and after operation were detected and compared.Results There were no significant differences in blood pressure,heart rate,RR,SpO2,anesthesia induction time,length of inspection and operation and anesthesia recovery time between the two groups at each time point of T0,T1 and T2(P>0.05).The FBG,CRP and ACTH in the two groups were all higher at T2 than at T0(P<0.05).Compared with the control group,the total dosage of propofol,the incidence of adverse reactions and the number of body movements during opera‐tion were significantly decreased in the observation group(P<0.05),the levels of postoperative CRP and ACTH were significantly de‐creased in the observation group(P<0.05).Conclusions The clinical effect and safety of nalbuphine 0.15 mg/kg combined with pro‐pofol in patients aged over 60 with painless ERCP were better than that of fentanyl 1.0μg/kg combined with propofol.