不同镇痛药物复合丙泊酚在经内镜逆行胰胆管造影术中的效果比较

Comparison of the effects of different analgesic drugs combined with propofol in endoscopic retrograde cholangiopancreatography

目的探讨不同镇痛药物复合丙泊酚在经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)术中的效果。方法选取2021年1月至2022年1月在秦皇岛市第一医院接受ERCP术治疗的120例患者作为研究对象,按照数字表法随机将其分为A组、B组和C组,每组各40例。A组患者使用布托啡诺复合丙泊酚麻醉,B组患者使用芬太尼复合丙泊酚麻醉,C组患者使用单纯的丙泊酚麻醉。比较3组患者在不同时点的平均动脉压(MAP)、呼吸频率(RR)、心率(HR)、血氧饱和度(SpO_(2)),丙泊酚的诱导剂量、维持剂量和苏醒时间,以及术后视觉模拟评分(VAS)、Ramsay镇静评分及不良反应发生情况。结果A组在麻醉前(T_(0))、置入内镜时(T_(1))、内镜下操作牵拉时(T_(2))、退镜时(T_(3))和苏醒时(T_(4))的MAP、RR、HR、SpO_(2)无明显变化(P>0.05),B组在T_(1)时点RR显著降低,C组在T_(1)时点MAP、RR均显著降低(P<0.05),3组在T_(1)时点的MAP、RR比较差异有统计学意义(P<0.05);A组和B组丙泊酚的诱导剂量、维持剂量、苏醒时间显著少于C组(P<0.05);A组和B组VAS评分、Ramsay镇静评分显著低于C组(P<0.05);A组和B组不良反应总发生率显著低于C组(P<0.05)。结论布托啡诺及芬太尼复合丙泊酚在ERCP术中的麻醉效果优于单独应用丙泊酚,可减少丙泊酚诱导剂量和维持剂量,患者苏醒更快,术后不良反应更少,应用布托啡诺复合丙泊酚麻醉的患者血流动力学更稳定。

Objective To investigate the effects of different analgesic drugs combined with propofol in endoscopic retrograde cholangiopancreatography(ERCP).Methods A total of 120 patients who received ERCP in the hospital from January 2021 to January 2022 were selected as research subjects,and were divided into group A,B and group C,according to the random number table method,each consisting of 40.The patients in group A were anesthetized with butorphanol combined with propofol,the patients in group B were anesthetized with fentanyl combined with propofol,and the patients in group C were simply treated with propofol.The mean arterial pressure(MAP),respiratory rate(RR),heart rate(HR),oxygen saturation(SpO_(2)),propofol induction dose,propofol maintenance dose,recovery time,postoperative visual analogue scale(VAS),Ramsay sedation scores and adverse reactions at different time points were compared between the three groups.Results There were no significant changes in MAP,RR,HR and SpO_(2) in group A at the time jpoints of T_(0)⁃T_(4)(P>0.05).RR in group B significantly decreased at T_(1),and MAP and RR in group C all significantly decreased at T_(1)(P<0.05).Statisticvasl significance could be noted in MAP and RR at T_(1),when comparisons were made between the three groups(P<0.05).The induction dose,maintenance dose of propofol and recovery time of group A and B were significantly lower than those of group C(P<0.05).The VAS scores and Ramsay sedation scores of group A and B were significantly lower than those of group C(P<0.05).The total rate of adverse reactions in group A and group B was significantly lower than that in group C(P<0.05).Conclusion Butorphanol and fentanyl combined with propofol in ERCP could produce better anesthetic effects than propofol alone.It could lower the induction and maintenance dose of propofol,hasten recovery of patients,reduce postoperative adverse reactions and stabilize hemodynamics of the patients treated with butorphanol combined with propofol.