气管插管静脉全麻与清醒状态下ERCP选择性胆管插管临床观察

Clinical Observation of Endotracheal Intubation Under Venous General Anesthesia and ERCP Intubation Under Awake State.

目的探讨气管插管静脉全麻ERCP整个操作过程中的应用价值。方法选取2020年1至12月我院内镜中心完成的气管插管静脉全麻ERCP胆总管切开取石患者32例,纳入观察组;清醒状态下完成的相同操作患者32例,纳入对照组。观察两组患者选择性胆管插管时间及全程手术时间。选择性胆管插管时间为清楚观察到十二指肠主乳头后开始插管至导丝顺利进入胆管方向,全程手术时间观察组为开始气管插管至手术结束,对照组为操作医生开始进镜至手术结束。结果观察组患者选择性胆管插管时间为(6.51±4.51)min,全程手术时间(32.51±4.81)min;对照组患者选择性胆管插管时间为(15.51±11.15)min,全程手术时间(40.81±10.51)min;统计学数据选择性胆管插管时间差异有统计学意义(P<0.05),全程手术时间差异有统计学意义(P<0.05)。术后并发症观察两组均未出现出血及穿孔;观察组有9例出现腹胀,对照组仅2例;观察组1例出现术后轻症胰腺炎,对照组出现4例,也均为轻症,差异有统计学意义(P<0.05)。结论气管插管静脉全麻下因患者麻醉镇静作用明显,胃肠道蠕动减少,且常规使用肌松药,十二指肠乳头括约肌不易因插管发生痉挛,所以选择性插管时成功率极高,故耗时短,在后期的胆管括约肌切开及胆总管取石过程也可显著缩短手术时间,有利于保障患者治疗质量,降低诊疗过程的痛苦感。

Objective To retrospectively analyze the intubation time and the whole operation time of patients undergoing ERCP.Methods Thirty-two patients who received ERCP under endotracheal intubation and intravenous anesthesia in the Endoscopic Center of our hospital from January to December,2020 were selected as the observation group.Another 32 patients who received ERCP under awake state were selected as the control group.The observation group received clinical operation by endotracheal intubation and intravenous anesthesia,while the control group received clinical operation under awake state.The intubation time,the whole operation time,the success rate of first lithotomy and the occurrence of postoperative adverse reactions were observed.The time of selective bile duct intubation was from the beginning of intubation after the duodenal primary papilla was clearly observed to the smooth entry of the guide wire into the bile duct.The whole operation time was from the beginning of endotracheal intubation to the end of surgery in the observation group,and from the beginning of endoscopy to the end of surgery in the control group.Results The selective intubation time and operation time in the observation group were(6.51±4.51)min and(32.51±4.81)min respectively;compared with those in control group(15.51±11.15)min and(40.81±10.51)min.Statistical data shows the time of selective bile duct intubation(P<0.05)and the whole operation(P<0.05)were statistically different between the two groups.Postoperative complications were observed without bleeding or perforation in both groups.There were 9 cases of abdominal distension in the observation group and only 2 cases in the control group.There was 1 case of postoperative mild pancreatitis in the observation group and 4 cases in the control group,all of which were mild,with statistically significant difference(P<0.05).Conclusion The sedative effect of endotracheal intubation and intravenous anesthesia for patients is obvious,with the decrease of gastrointestinal peristalsis.In addition,the spasm of the duodenal papillary sphincter is not easily caused by intubation with routine use of muscle relaxation agents,so the success rate of selective intubation is very high,and the operation time is short.In the later stages of biliary sphincterotomy and common bile duct lithotomy,the operation time can also be significantly shortened,which is beneficial to ensure the quality of treatment for patients and reduce the pain in the diagnosis and treatment process.