不同剂量丙泊酚靶控输注麻醉对内镜逆行性胰胆管造影联合内镜括约肌切开术下胆总管结石患者血流动力学镇痛及安全性的影响

Effects of different doses of propofol target-controlled infusion anesthesia on hemodynamics,analgesia,and safety in patients with common ble duct stones undergoing endoscopic retrograde cholangiopancre-atography combined with endoscopic sphincterotomy

目的探讨不同剂量丙泊酚靶控输注麻醉在内镜逆行性胰胆管造影(ERCP)联合内镜下括约肌切开术治疗胆总管结石的临床观察。方法2019年12月至2023年1月选取浙江省丽水市人民医院就诊的300例胆总管结石并行ERCP联合内镜下括约肌切开术的患者,按剂量将其分为低剂量丙泊酚(LP)组,中剂量丙泊酚(MP)组和高剂量丙泊酚(HP)组,每组100例,LP组、MP组、HP组均进行丙泊酚靶控输注,剂量分别为1μg/ml、3μg/ml、5μg/ml,观察并分析3组临床相关指标。结果T0、T1、T2、T3、T4、T5时LP组的平均动脉压(MAP)分别为(88±6)mmHg、(77±5)mmHg、(71±5)mmHg、(70±5)mmHg、(75±5)mmHg、(84±7)mmHg;MP组分别为(87±6)mmHg、(78±5)mmHg、(70±5)mmHg、(70±5)mmHg、(76±6)mmHg、(83±6)mmHg;HP组分别为(88±6)mmHg、(77±5)mmHg、(71±5)mmHg、(71±5)mmHg、(75±5)mmHg、(83±6)mmHg。T0、T1、T2、T3、T4、T5时LP组的心率分别为(78±6)次/min、(73±5)次/min、(67±5)次/min、(68±5)次/min、(71±6)次/min、(80±6)次/min;MP组分别为(78±6)次/min、(72±5)次/min、(68±5)次/min、(67±5)次/min、(71±6)次/min、(80±6)次/min;HP组分别为(78±6)次/min、(73±5)次/min、(67±5)次/min、(67±5)次/min、(72±6)次/min、(79±6)次/min。在T0时,3组MAP、心率水平、视觉模拟评分(VAS)对比差异无统计学意义(P>0.05),在T1、T2时,3组的MAP、心率均降低(P<0.05),但3组MAP、心率水平对比差异无统计学意义(P>0.05),T2与T3时3组MAP、心率水平对比差异无统计学意义(P>0.05),而在T4、T5时,3组MAP、心率水平均升高,但3组MAP、心率水平对比差异无统计学意义(P>0.05),组间与时间不存在相互作用(F=0.249,P=0.991)。T0、T1、T2、T3、T4、T5时LP组的VAS评分分别为(4.25±0.22)分、(2.34±0.15)分、(2.41±0.16)分、(2.38±0.14)分、(4.33±0.23)分、(5.21±0.26)分;MP组分别为(4.35±0.24)分、(1.85±0.14)分、(1.82±0.13)分、(1.84±0.12)分、(3.65±0.14)分、(4.78±0.21)分;HP组分别为(4.30±0.23)分、(1.36±0.11)分、(1.33±0.11)分、(1.37±0.12)分、(2.96±0.13)分、(3.55±0.18)分。T1、T2、T3时3组VAS评分降低(P<0.05),且与LP组相比,MP组降低(P<0.05),与MP组相比,HP组降低(P<0.05),T4、T5时3组VAS评分均升高,且LP组比MP组、HP组升高明显(P<0.05),组间与时间存在相互作用。与LP组相比,MP组手术时间、术中出血量、住院时间比较差异无统计学意义(P>0.05),与MP组对比,HP组手术时间、术中出血量、住院时间比较差异无统计学意义(P>0.05);与LP组相比,MP组呼吸恢复时间、苏醒时间、拔管时间比较差异无统计学意义(P>0.05),与MP组相比HP组呼吸恢复时间、苏醒时间、拔管时间比较差异无统计学意义(P>0.05)LP组、MP组、HP组恶心呕吐、呼吸抑制、高血压、心动过缓、谵妄不良反应发生率分别为21.0%、25.0%、30.0%,组间相比差异无统计学意义(χ^(2)=2.150,P>0.05)。结论低中高剂量丙泊酚既不会改变血流动力学,也不会延长苏醒时间,且高剂量丙泊酚镇痛效果更好,提示丙泊酚靶控输注麻醉在ERCP联合内镜下括约肌切开术治疗胆总管结石中具有满意效果,且安全性较高。

Objective To investigate the clinical observation of different doses of propofol target controlled infusion anesthesia in the treatment of choledocholithiasis by ERCP combined with endoscopic sphinctero-tomy.Methods A total of 300 patients with choledocholithiasis undergoing ERCP combined with endoscopic sphincterotomy at Lishui People′s Hospital from December 2019 to January 2023 were selected and divided into low-dose propofol(LP)group,medium-dose propofol(MP)group,and high-dose propofol(HP)group,with 100 cas-es in each group.The LP group,MP group,and HP group were all administered propofol target controlled infusion at doses of 1,3,and 5μg/ml,respectively.The clinically relevant indicators of the three groups were observed and analyzed.Results The MAP of LP group at T0,T1,T2,T3,T4 and T5 were(88±6)mmHg,(77±5)mmHg,(71±5)mmHg,(70±5)mmHg,(75±5)mmHg and(84±7)mmHg,respectively;The MP group was(87±6)mmHg,(78±5)mmHg,(70±5)mmHg,(70±5)mmHg,(76±6)mmHg,(83±6)mmHg,respectively.The HP group was(88±6)mmHg,(77±5)mmHg,(71±5)mmHg,(71±5)mmHg,(75±5)mmHg,(83±6)mmHg,respectively.The HR of LP group at T0,T1,T2,T3,T4 and T5 were(78±6)beats per minute,(73±5)beats per minute,(67±5)beats per minute,(68±5)beats per minute,(71±6)beats per minute and(80±6)beats per minute,respectively;MP group was(78±6)beats per minute,(72±5)beats per minute,(68±5)beats per minute,(67±5)beats per minute,(71±6)beats per minute,(80±6)beats per minute,respectively.They were(78±6)beats per minute,(73±5)beats per minute,(67±5)beats per minute,(67±5)beats per minute,(72±6)beats per minute,(79±6)beats per minute,respectively.At T0,there were no significant differences in MAP,HR levels and VAS scores among the three groups(P>0.05);at T1 and T2,MAP and HR levels of the three groups were significantly decreased(P<0.05),but there were no signifi-cant differences in MAP and HR levels among the three groups(P>0.05).There was no significant difference in the comparison of MAP and HR levels among the three groups at T2 and T3(P>0.05),while at T4 and T5,the MAP and HR levels were significantly increased,but there was no significant difference in the comparison of MAP and HR levels among the three groups(P>0.05),and there was no interaction between groups and time(F=0.249,P=0.991).The VAS scores of LP group at T0,T1,T2,T3,T4 and T5 were(4.25±0.22)points,(2.34±0.15)points,(2.41±0.16)points,(2.38±0.14)points,(4.33±0.23)points and(5.21±0.26)points,respectively.In MP group,the results were(4.35±0.24),(1.85±0.14),(1.82±0.13),(1.84±0.12),(3.65±0.14)and(4.78±0.21),respectively.In HP group,they were(4.30±0.23)points,(1.36±0.11)points,(1.33±0.11)points,(1.37±0.12)points,(2.96±0.13)points and(3.55±0.18)points.VAS scores in T1,T2 and T3 groups were significantly decreased(P<0.05),and compared with LP group,the MP group was significantly decreased(P<0.05),compared with MP group,the HP group was significantly decreased(P<0.05),and the VAS scores in T4 and T5 groups were increased,and the LP group was significantly increased than MP and HP groups(P<0.05).There is an interaction between groups and time group(P<0.001).Compared with LP group,there were no significant differences in operation time,intraoperative blood loss and hospital stay in MP group(P>0.05),while there were no significant differences in operation time,intraop-erative blood loss and hospital stay in HP group(P>0.05).Compared with LP group,there were no significant dif-ferences in respiratory recovery time,wake time and extubation time in MP group(P>0.05).There were no signifi-cant differences in respiratory recovery time,wake time and extubation time in HP group(P>0.05).The adverse reactions of nausea,vomiting,respiratory depression,hypertension,bradycardia and delirium in LP group,MP group and HP group were 21.0%,25.0%and 30.0%,respectively,and there were no significant differences a-mong groups(χ^(2)=2.150,P>0.05).Conclusions Low,medium and high doses of propofol can neither change hemodynamics nor prolong the recovery time,and high doses of propofol have better analgesic effect,suggesting that propofol target controlled infusion anesthesia has a satisfactory effect and high safety in the treatment of com-mon choledocholithiasis with ERCP combined with endoscopic sphincterotomy.