无肌松药下丙泊酚复合瑞芬太尼气管插管全麻在老年患者ERCP诊疗中的应用

Propofol combined with remifentanil in general anesthesia with tracheal intubation without muscle relaxant for ERCP in elderly patients

目的探讨无肌松药下丙泊酚复合瑞芬太尼气管插管全麻在老年患者经内镜逆行胰胆管造影术(ERCP)诊疗中的可行性及临床效果。方法选择2018年10月至2020年10月行ERCP术的老年患者180例,按照麻醉方式分为C组(基础静脉麻醉)、N组(气管插管全麻过程中未使用肌松药)和M组(气管插管全麻过程中使用肌松药),每组60例。三组术中均复合泵注小剂量去甲肾上腺素。记录三组入室后(T_(0))、内镜置入咽部(T_(1))、操作稳定时(T_(2))、手术结束时(T_(3))的心率(HR)、平均动脉压(MAP)、指脉氧饱和度(SpO_(2))、呼吸频率(RR)以及N组和M组气道压值(Ppeak)。记录气管插管并发症(呛咳、喉痉挛、拔管后咽痛或声嘶等);术中体动、呼吸抑制发生情况。记录N组和M组的呼之睁眼时间、拔管时间及麻醉后监护室(PACU)停留时间。结果与本组入室后T_(0)比较,三组患者T_(1)时HR降低,T_(1)、T_(2)、T_(3)时SpO_(2)升高,而C组T_(1)、T_(2)、T_(3)时RR降低,差异有统计学意义(P<0.01)。N组和M组T_(1)、T_(2)、T_(3)时SpO_(2)显著高于C组同时间点(P<0.01)。N组和M组组间及组内各时间点Ppeak比较差异无统计学意义(P>0.05)。气管插管过程中,N组和M组均未发生喉痉挛;N组发生呛咳5例,M组未发生呛咳;术后随访均未出现咽痛及声嘶。三组术中体动、呼吸抑制发生率差异有统计学意义(P<0.01),均为C组最高。术后N组呼之睁眼时间、拔管时间及PACU停留时间均短于M组(P<0.01)。结论无肌松药下丙泊酚复合瑞芬太尼气管插管全麻用于老年患者ERCP,既可避免呼吸抑制,同时又具有苏醒快、拔管早等优势,可改善患者术后的麻醉恢复及转运的效率。

Objective To investigate the feasibility and clinical effect of propofol and remifentanil in general anesthesia with tracheal intubation without muscle relaxants in elderly patients undergoing ERCP.Methods A total of 180 elderly patients from October 2018 to October 2020 received elective ERCP were divided into group C(basic intravenous anesthesia),group N(no muscle relaxants during general anesthesia)and group M(muscle relaxants used during general anesthesia)according to anesthesia methods(n=60,each).Low-dose norepinephrine was infused during the operation in three groups.At four time points[entering the room(T_(0)),endoscope inserted through the pharynx(T_(1)),operation stable(T_(2))and end of operation(T_(3))],the values of HR,MAP,SpO_(2),RR in three groups and Ppeak in group N and group M were recorded.Complications of tracheal intubation(coughing,laryngospasm,sore throat or hoarseness after extubation,etc.)were observed,and the occurrence of body movement and respiratory depression during operation were recorded.Eye-opening time,extubation time and PACU stay time in group N and M were recorded also.Results Compared with T_(0),HR decreased significantly at T_(1),SpO_(2)increased significantly at T_(1),T_(2)and T_(3)in three groups,and RR decreased significantly at T_(1),T_(2)and T_(3)in group C(P<0.01).SpO_(2)in group N and group M were significantly higher than that in group C at T_(1),T_(2)and T_(3)(P<0.01).There were no significant differences in Ppeak between group N and group M at each time point(P>0.05).During tracheal intubation,no laryngospasm occurred in group N and M,coughing occurred in 5 cases in group N.and no coughing occurred in group M.There was no sore throat or hoarseness in the postoperative follow-up.The differences in the incidence of body movement and respiratory depression in the three groups were statistically significant(P<0.01),all of which were the highest in group C.After operation,the time of eye-opening,extubation and PACU stay in group N were significantly shorter than those in group M(P<0.01).Conclusion In elderly patients undergoing ERCP,propofol combined with remifentanil for general anesthesia without muscle relaxants cannot only avoid respiratory depression,but also has the advantages of quick recovery and early extubation,which can improve the postoperative recovery and transport efficiency of patients.