艾司氯胺酮联合环泊酚在经内镜逆行胰胆管造影术中的应用

Application of esketamine combined with ciprofol in endoscopic retrograde cholangio-pancreatography

目的探讨艾司氯胺酮联合环泊酚在经内镜逆行胰胆管造影术(Endoscopic retrograde cholangio-pancreatography,ERCP)中麻醉效果的差异。方法选取2021年1月至2022年6月北部战区总医院行ERCP老年患者100例,按照随机数字表法分为2组,对照组采用舒芬太尼联合丙泊酚,试验组为艾司氯胺酮联合环泊酚。比较两组患者T0(入室时)、T1(诱导后)、T2(进镜时)、T3(开始手术操作时)、T4(苏醒时)不同时间点的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO _(2))的变化情况及术中与术后不良反应发生率。结果在T0与T1时,两组患者MAP、HR、SpO _(2)变化差异无统计学意义(P>0.05)。在T2、T3、T4时,两组患者的MAP、HR、SpO _(2)差异存在统计学意义,试验组波动小于对照组(P<0.05)。与对照组相比,试验组术中低血压、呼吸抑制及心动过缓发生率显著降低且苏醒及出室时间明显缩短,差异有统计学意义(P<0.05);而体动、呛咳、术后谵妄、恶心呕吐差异无统计学意义(P>0.05)。结论艾司氯胺酮联合环泊酚用于ERCP术中血流动力学更稳定,不良反应发生率更低,苏醒及出室时间更短。

Objective To investigate the differences in the anesthetic effect of esketamine combined with ciprofol in endoscopic retrograde cholangio-pancreatography(ERCP).Methods A total of 100 elderly patients receiving ERCP in the Northern Theater Command General Hospital from January 2021 to June 2022 were selected and divided into two groups according to random number table method:the control group received sufentanil combined with propofol,and the experimental group received esketamine combined with ciprofol.The changes in mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO _(2))and the incidence of intraoperative and postoperative adverse reactions in both groups were compared at different time points of T0(on entering the room),T1(after induction),T2(on applying endoscopy),T3(at the beginning of operation)and T4(on recovery).Results Compared with T0,there was no significant difference in MAP,HR or SpO _(2) in both groups at T1(P>0.05).At T2,T3 and T4,statistical differences were observed in MAP,HR and SpO _(2) in the two groups,and the fluctuation of the experimental group was less than that of the control group(P<0.05).Compared with the control group,the incidence of hypotension,respiratory depression and bradycardia in experimental group were significantly reduced,and the time for recovery and to exit the room was significantly shortened(P<0.05).Additionally,there was no significant difference in body movement,choking cough,postoperative delirium,nausea or vomiting between the two groups(P>0.05).Conclusion Esketamine combined with ciprofol for ERCP is more stable in hemodynamics,and has less incidence of adverse reaction and shorter time for recovery and to exit the room.