右美托咪定和舒芬太尼复合丙泊酚用于老年患者内镜逆行胰胆管造影术深度镇静的比较

Comparison of dexmedetomidine and sufentanil combined with propofol for deep sedation undergoing endoscopic retrograde cholangiopancreatography in elderly patients

目的 比较右美托咪定和舒芬太尼复合丙泊酚用于内镜逆行胰胆管造影术(ERCP)老年患者深度镇静的效果和安全性。方法 选择2022年7—10月择期行ERCP的老年患者60例,年龄65~90岁,BMI 15~33 kg/m^(2),ASAⅠ—Ⅲ级,心功能正常或NHYA分级Ⅰ或Ⅱ级。采用随机数表法将患者分为两组:右美托咪定组(D组)和舒芬太尼组(S组),每组30例。D组静脉泵注右美托咪定0.5μg/kg,持续10 min,之后缓慢静脉注射丙泊酚1 mg/kg进行麻醉诱导(给药时间>30 s);S组缓慢静脉注射舒芬太尼0.12μg/kg后,予丙泊酚1 mg/kg进行麻醉诱导(给药时间>30 s)。记录手术时间、丙泊酚用量、术中体动发生情况。记录术中最低SpO_(2)、气道干预例数、低氧血症发生情况。记录术中心动过速、心动过缓、高血压、低血压和心律失常等心血管不良事件发生情况。记录苏醒时间、入PACU后15 min静息时VAS疼痛评分、术后中重度疼痛(VAS疼痛评分≥4分)和PACU内恶心呕吐发生情况。结果 两组Ramsay评分均≥5分,镇静效果满意。与S组比较,D组术中最低SpO_(2)、心动过缓发生率明显升高(P<0.05),气道干预率、低氧血症、心动过速、低血压发生率明显降低(P<0.05),苏醒时间明显延长(P<0.05)。两组手术时间、丙泊酚用量、体动率和高血压发生率、入PACU后15 min静息时VAS疼痛评分、中重度疼痛以及PACU内恶心呕吐发生率差异均无统计学意义。结论 应用右美托咪定和舒芬太尼复合丙泊酚均能达到满意的深度镇静效果,右美托咪定复合丙泊酚时术中血流动力学更稳定,并且术中低氧血症和心血管不良事件发生率更低。

Objective To compare the sedative efficacy and safety of dexmedetomidine and sufentanil combined with propofol in elderly patients undergoing endoscopic retrograde cholangiopancreatography(ERCP).Methods Sixty elderly patients from July to October 2022,aged 65-90 years,BMI 15-33 kg/m^(2),ASA physical statusⅠ-Ⅲ,had normal cardiac function or NHYA gradeⅠorⅡ,underwent ERCP were enrolled.Patients were divided into two groups by random number table method:the dexmedetomidine group(group D)and the sufentanil group(group S),30 patients in each group.Group D received an intravenous infusion of dexmedetomidine 0.5μg/kg for 10 minutes followed by intravenous propofol 1 mg/kg for sedation induction.Group S received intravenous sufentanil 0.12μg/kg followed by intravenous propofol 1 mg/kg for sedation induction.The operation time,total dosage of propofol,incidence of body movement were recorded.The lowest SpO_(2),use of airway interventions,incidence of hypoxemia were recorded.Adverse cardiovascular events(tachycardia,bradycardia,hypertension,hypotension,and arrhythmia)were recorded.Awakening time,VAS pain scores at rest 15 minutes after entering PACU,incidence of moderate to severe postoperative pain,and postoperative nausea and vomiting in PACU were recorded.Results Adequate deep sedation was successfully achieved in the two groups(Ramsay scale≥5 scores).Compared with group S,the lowest SpO_(2) and bradycardia were significantly increased(P<0.05),the use of airway interventions,hypoxemia,tachycardia,and hypotension were significantly decreased in group D(P<0.05).There were no significant differences in operation time,total dosage of propofol,incidence of body movement,hypertension,VAS pain scores at rest 15 minutes after entering PACU,moderate to severe postoperative pain,and postoperative nausea and vomiting in PACU between the two groups.Conclusion Dexmedetomidine or sufentanil combined with propofol can provide adequate deep sedation for ERCP procedure.Dexmedetomidine combined with propofol can keep intraoperative cardiovascular function more stable,and reduce the occurrence of intraoperative hypoxemia and cardiovascular adverse events.