地佐辛对内镜逆行胰胆管造影术麻醉效果及应激反应的影响

Effects of dezocine on endoscopic retrograde cholangiopancreatography anesthesia and stress response

目的:探讨在内镜逆行胰胆管造影术(ERCP)麻醉中应用地佐辛的临床效果及其安全性。方法:纳入2018年1月至2020年12月在河南中医药大学第一附属医院接受ERCP的100例患者作为研究对象,其中47例患者麻醉方案为舒芬太尼复合丙泊酚,设为对照组;53例患者麻醉方案为地佐辛复合丙泊酚,设为观察组。分析两组患者麻醉效果和丙泊酚使用剂量情况,同时分析两组围手术期生命体征指标变化、应激指标和不良反应发生情况。结果:两组麻醉起效时间相近(P>0.05);观察组术后苏醒时间显著短于对照组(P<0.05),术中体动次数和丙泊酚使用剂量均少于对照组(P<0.05)。两组T0(诱导前)、T4(术毕即时)和T5(苏醒即时)的心率、舒张压、收缩压及血氧饱和度指标相近(P>0.05),T0、T1(诱导后即时)、T4和T5的呼吸频率相近(P>0.05);观察组T1、T2(手术操作起5 min)和T3(手术操作起30 min)的心率、舒张压、收缩压及血氧饱和度均高于对照组(P<0.05),T2和T3的呼吸频率快于对照组(P<0.05)。两组术前皮质醇(Cor)、C反应蛋白(CRP)、促肾上腺皮质激素(ACTH)指标相近(P>0.05);观察组术中和术后的Cor、CRP、ACTH低于对照组(P<0.05)。两组呃逆、呛咳、体动、眩晕、恶心呕吐的单独发生率无显著差异(P>0.05),但是观察组的呼吸抑制单独发生率和不良反应总发生率低于对照组(P<0.05)。结论:地佐辛用于ERCP麻醉中的效果良好,麻醉起效快且术后苏醒较快,对围手术期患者机体应激反应影响较小,同时还利于维持患者术中生命体征的平稳,不良反应发生率较低,可见其麻醉效果良好且安全性较高。

Objective:To study the clinical efficacy and safety of dezocine in endoscopic retrograde cholan-gio-pancreatography(ERCP)anesthesia.Methods:The perioperative data of 100 patients who re-ceived ERCP in The First Affiliated Hospital of Henan University of CM from January 2018 to De-cember 2020 were retrospectively analyzed.Among them,47 patients were treated with sufentanil combined with propofol as the control group.A total of 53 patients were treated with dexocine com-bined with propofol as the observation group.The anesthesia effect and propofol dosage of patients in the two groups were analyzed,and the changes in perioperative vital signs,stress indexes,and ad-verse reactions of the two groups were also analyzed.Results:By comparing the anesthetic effect and the dosage of propofol in the two groups,it was found that the effective time of the two groups was similar(P>0.05).The postoperative recovery time was significantly shorter than that of the control group(P<0.05),and the number of body movements and the dosage of propofol were significantly shorter than that of the control group(P<0.05).By comparing the changes in perioperative vital signs between the two groups,it was found that their mean heart rate,diastolic blood pressure(and systolic blood pressure and oxygen saturation)at T0(before induction),T4(immediately after the operation),and T5(immediately after awakening)were similar(P>0.05).Their respiratory rates at T0,T1(im-mediately after induction),T4(immediately after operation closure),and T5(immediately after awak-ening)were similar(P>0.05).The heart rate,diastolic blood pressure,systolic blood pressure,and oxygen saturation at T1,T2(5 min after operation),and T3(30 min from the operation)in the obser-vation group were higher than those in the control group(P<0.05).The respiratory rate at T2 and T3 was faster than that in the control group(P<0.05).Preoperative cortisol(Cor),C-reactive protein(CRP),and adrenocorticotropin(ACTH)were similar between the two groups(P>0.05).Cor,CRP,and ACTH in the observation group were lower than those in the control group(P<0.05).By comparing the incidence of adverse reactions,it was found that there was no significant difference in the incidence of hiccups,choking,body movement,dizziness,nausea,and vomiting between the two groups(P>0.05),but the incidence of respiratory depression alone and the total incidence of adverse reactions in the observation group was lower than that in the control group(P<0.05),and the inci-dence of vertigo alone was higher than that in the control group(P<0.05).Conclusion:Dezocine is effective for ERCP anesthesia,with rapid onset of anesthesia and rapid postoperative recovery.It has little influence on the body stress response of patients in the perioperative period,and is also beneficial to maintain the stability of patients'intraoperative vital signs,with a low incidence of adverse reac-tions,indicating good anesthesia effect and high safety.