无肌松药经鼻气管插管全身麻醉在老年病人经内镜逆行性胰胆管造影术中的应用

Application of general anesthesia without muscle relaxant through nasal tracheal intubation in elderly patients receiving ERCP

目的观察和评价无肌松药经鼻气管插管全身麻醉在老年病人行内镜逆行胰胆管造影术(ERCP)中应用的可行性。方法选择2019年4月至2021年4月于我院内镜中心行ERCP的老年病人180例,随机分为使用肌松药的经口气管插管全身麻醉(S)组和不使用肌松药经鼻气管插管全身麻醉(N)组,每组90例。记录2组病人入室时(T_(0))、麻醉诱导时(T_(1))、气管插管时(T_(2))、十二指肠乳头插管或切开oddis括约肌时(T_(3))、拔管后(T_(4))的心率(HR)、平均动脉压(MAP)、SpO_(2)、脑电双频指数(BIS)值,以及病人自主呼吸恢复时间、拔管时间、恢复室(PACU)滞留时间、血流动力学不良事件。结果2组组内比较,与T_(0)比较,T_(1)、T_(2)、T_(3)时HR、MAP、BIS均明显降低,SpO_(2)升高,T_(4)时SpO_(2)降低;与T_(1)比较,T_(3)时MAP,T_(4)时HR、MAP、BIS升高,SpO_(2)降低;与T_(2)、T_(3)比较,T_(4)时HR、MAP、BIS升高,SpO_(2)降低(P<0.05)。2组间比较,T_(1)、T_(2)时HR,T_(4)时SpO_(2)差异均有统计学意义(P<0.05)。N组的呼吸恢复时间、拔管时间、PACU滞留时间短,术后低氧血症发生率低,明显优于S组。结论不使用肌松药经鼻气管插管全身麻醉在老年ERCP病人手术中应用,可以避免肌松残余,具有苏醒快、拔管早,利于病人恢复及内镜中心运转的优势。

Objective To observe and evaluate the feasibility of general anesthesia without muscle relaxant through nasal tracheal intubation in the elderly patients receiving endoscopic retrograde cholangiopancreatography(ERCP).Methods A total of 180 elderly patients who underwent ERCP in endoscopy center of our hospital from April 2019 to April 2021 were randomly divided into tracheal intubation general anesthesia group using muscle relaxant(group S)and nasal tracheal intubation general anesthesia group without muscle relaxant(group N),with 90 cases in each group.At five time points as entering the room(T_(0)),anesthesia induction(T_(1)),endotracheal intubation(T_(2)),intubation of duodenal papilla or incision of oddis sphincter(T_(3)),post-extubation(T_(4)),the levels of heart rate(HR),mean arterial pressure(MAP),pulse oxygen saturation(SpO_(2)),bispectral index(BIS)value were recorded and the recovery time of spontaneous breathing,extubation time,postanesthesia care unit(PACU)retention time were detected,and the adverse events were recorded.Results In both groups,compared with T_(0),the levels of HR,MAP and BIS were significantly decreased and the level of SpO_(2) was significantly increased at T_(1),T_(2) and T_(3),and the level of SpO_(2) was decreased at T_(4);Compared with T_(1),the level of MAP was increased at T_(3),and the levels of HR,MAP and BIS were increased,while the level of SpO_(2) was decreased at T_(4);Compared with T_(2) and T_(3),the levels of HR,MAP and BIS were increased and the level of SpO_(2) was decreased at T_(4)(P<0.05).The level of HR at T_(1) and T_(2),and the level of SpO_(2) at T_(4) showed significant differences between group N and group S(P<0.05).The time of respiratory recovery,extubation and PACU stay in group N were significantly shorter than those in group S,and the incidence rate of postoperative hypoxemia was significantly lower than that in group S.Conclusions In the elderly patients undergoing ERCP,general anesthesia without muscle relaxants can avoid muscle relaxant remnants,which can improve the recovery of the postoperative patients,and be helpful to the transport in endoscopy center.