右美托咪定联合七氟烷对行内镜逆行性胰胆管造影患者血流动力学波动和吸入麻醉需求量的影响

Effects of dexmedetomidine combined with sevoflurane on hemodynamic fluctuations and need for inhalation anesthesia in patients undergoing endoscopic retrograde cholangio pancreatography

目的研究右美托咪定联合七氟烷对行内镜逆行性胰胆管造影(ERCP)患者血流动力学波动和吸入麻醉需求量的影响。方法前瞻性选取2020年7月至2021年2月于山东省第二人民医院择期行ERCP的104例患者,按随机数字表法分为A、B两组,各52例。麻醉诱导前,A组给予瑞芬太尼,B组给予右美托咪定,诱导、气管插管后吸入七氟烷。比较两组术后疼痛程度,监测患者泵注前(T0)、泵注10 min后(T1)、气管插管时(T2)、插管1 min后(T3)、手术开始(T4)、手术开始15 min后(T5)、进入复苏室时(T6)、拔管时(T7)、拔管后1 min(T8)时血流动力学波动、麻醉有关时间、吸入七氟烷剂量与不良反应情况。结果两组在拔管时、术后24 h的视觉模拟评分法(VAS)评分比较,差异均无统计学意义(P>0.05)。T0时刻两组心率、平均动脉压比较,差异均无统计学意义(P>0.05);B组T2~T8时刻的心率低于A组,T3、T4时刻的平均动脉压低于A组,差异均有统计学意义(P<0.05)。两组麻醉、苏醒及拔管时间比较,差异均无统计学意义(P>0.05)。B组吸入七氟烷需求量、单位时间用量为(10.72±3.45)mL、(10.12±1.76)mL/h,少于A组[(13.58±3.67)mL、(13.92±2.33)mL/h],差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论相对于瑞芬太尼,右美托咪定联合七氟烷能更好稳定ERCP患者术中血流动力学,且减少吸入七氟烷的需求量,是一种安全有效的麻醉方法。

Objective To investigate the effects of dexmedetomidine combined with sevoflurane on hemodynamic fluctuations and need for inhalation anesthesia in patients undergoing endoscopic retrograde cholangio pancreatography(ERCP).Methods A sample of 104 patients undergoing ERCP in Shandong Second People's Hospital from July 2020 to February 2021 were enrolled,and divided into two groups using random number table methods,each with 52 cases.Before induction of anesthesia,group A was given remifentanil,while group B was given dexmedetomidine for induction and inhalation of sevoflurane after tracheal intubation.The postoperative pain levels of the two groups were compared,before the infusion(T0),10 minutes after the infusion(T1),during tracheal intubation(T2),1 minute after intubation(T3),at the beginning of the operation(T4),and at the beginning of the operation.After 15 minutes(T5),when entering the resuscitation room(T6),when extubation(T7),and 1 minute after extubation(T8),hemodynamic fluctuations,time related to anesthesia,inhaled sevoflurane dose and adverse reactions be monitored.Results There was no statistically significant difference in the visual analogue scale(VAS)scores between the two groups at the time of extubation and 24 hours after operation(P>0.05).Heart rate and mean arterial pressure at T0 showed no statistically significant difference between the two groups(P>0.05).In group A,heart rate at T1~T5 was lower than that at T0,mean arterial pressure at T2~T5 was lower than that at T0,and heart rate and mean arterial pressure at T7 and T8 were higher than those at T0,the differences were statistically significant(P<0.05).In group B,heart rate at T4~T6 was lower than that at T0,the mean arterial pressure at T1~T5 was lower than that at T0,and the mean arterial pressure at T8 was higher than that at T0,the differences were statistically significant(P<0.05).The heart rate at T2~T8 in group B was lower than that in group A,and the mean arterial pressure at T3 and T4 was lower than that in group A,the differences were statistically significant(P<0.05).The time of anesthesia,anesthesia recovery and extubation indicated no statistically significant differences between the two groups(P>0.05).The sevoflurane dose and dose per unit time in group B were(10.72±3.45)mL,(10.12±1.76)mL/h,which were significantly lower than those of group A[(13.58±3.67)mL,(13.92±2.33)mL/h],the differences were statistically significant(P<0.05).The adverse reaction rate had no statistically significant difference between the two groups(P>0.05).Conclusion Compared with remifentanil,application of dexmedetomidine combined with sevoflurane in ERCP can effectively stabilize intraoperative hemodynamics and reduce the need for sevoflurane inhalation,which is a safe and effective method.