盐酸羟考酮复合丙泊酚靶控输注处理接受内镜治疗的胆总管结石患者麻醉效果研究

Anesthesia of oxycodone hydrochloride and propofol combination by target-controlled infusion in patients with choledocholithiasis undergoing ERCP treatment

目的探讨应用盐酸羟考酮复合丙泊酚靶控输注对接受内镜治疗的胆总管结石患者的麻醉效果。方法2021年6月~2023年6月我院诊治的胆总管结石患者75例,被随机分为对照组37例和观察组38例。两组均接受内镜下逆行胰胆管造影(ERCP)胆总管取石术治疗。在对照组,采用靶控输注丙泊酚联合瑞芬太尼麻醉,给予观察组静脉输注盐酸羟考酮联合靶控输注丙泊麻醉。在诱导前(T0)、诱导后5 min(T1)、进镜至十二指肠乳头时(T2)和术毕(T3)平均动脉血压(MAP)、心率(HR)和麻醉深度(BIS);采用放射免疫法检测血浆皮质醇(Cor),采用ELISA法检测血浆去甲肾上腺素(NE),采用己糖激酶法检测血糖(Glu)水平。分别应用Ramsay评分和视觉模拟评分(VAS)评估镇静和镇痛效果。结果在T2时,观察组MAP比对照组降低了2.8%(95%CI:-5.0%~0.1%,P<0.05),HR比对照组降低了4.3%(95%CI:-6.6%~-0.1%,P<0.05),BIS比对照组降低了2.1%(95%CI:-2.4%~-0.2%,P<0.05);观察组血清Cor水平比对照组降低了-11.7%(95%CI:-13.6%~1.1%,P<0.05),NE比对照组降低了10.3%(95%CI:-15.4%~0.04%,P<0.05),Glu比对照组降低了11.9%(95%CI:-16.2%~1.7%,P<0.05);在苏醒后30 min(N1)和苏醒2 h(N2)时,观察组VAS评分分别降低了14.3%(95%CI:-16.0%~1.6%,P<0.05)和16.0%(95%CI:-18.1%~1.9%,P<0.05);观察组丙泊酚用量比对照组减少了9.6%(95%CI:-14.7%~3.1%,P<0.05)。结论应用盐酸羟考酮复合丙泊酚靶控输注麻醉接受内镜治疗的胆总管结石患者术中血流动力学影响相对较小,可维持稳定的麻醉深度,减轻应激反应和术后疼痛,丙泊酚用量减少。

Objective The aim of this study was to investigate anesthesia of oxycodone hydrochloride and propofol combination by target-controlled infusion in patients with choledocholithiasis undergoing endoscopic retrograde cholangiopancreatography(ERCP)treatment.Methods In this clinical trial,we enrolled 75 patients with imaging-confirmed choledocholithiasis between June 2021 and June 2023,and all underwent ERCP for removal of common bile duct stones.We randomly assigned patients to receive target-controlled infusion of propofol and remifentanil(control,n=37)or intravenous infusion of oxycodone hydrochloride before target-controlled infusion of propofol for anesthesia induction and maintenance.The mean arterial pressure(MAP),heart rate(HR)and anesthesia depth(BIS)were routinely monitored before induction(T0),5 min after induction(T1),at the time of endoscopy to duodenal papilla(T2)and at the end of surgery(T3).Serum cortisol(Cor)levels was detected by radioimmunoassay,serum norepinephrine(NE)level was measured by ELISA,and serum glucose(Glu)level was detected by hexokinase method.Ramsay score was used to evaluate the sedation status,and visual analogue scale(VAS)was adopted to evaluate the analgesia effect.Results By T2,MAP in the observation decreased by 2.8%(95%CI:-5.0%-0.1%,P<0.05),HR decreased by 4.3%(95%CI:-6.6%-0.1%,P<0.05),and BIS decreased by 2.1%(95%CI:-2.4%-0.2%,P<0.05)as compared to in the control;serum Cor level decreased by-11.7%(95%CI:-13.6%-1.1%,P<0.05),serum NE level decreased by 10.3%(95%CI:-15.4%-0.04%,P<0.05),and blood Glu level decreased by 11.9%(95%CI:-16.2%-1.7%,P<0.05)compared to those in the control;by 30 minutes after waking-up(N1)and 2 hours after waking-up (N2), the VAS scores in the observation decreased by 14. 3% (95% CI:-16. 0% -1. 6%, P<0. 05) and 16. 0% (95%CI:-18. 1% -1. 9%,P<0. 05) as compared to those in the control;the dosage of propofol used in the observation decreased by 9. 6%(95%CI:-14. 7% -3. 1%, P<0. 05) compared to that in the control. Conclusion The intravenous administration of oxycodone hydrochloride and target-controlled infusion of propofol for anesthesia in patients with choledocholithiasis undergoing ERCP has clinically meaningful anesthesia, with relatively small effect on intraoperative hemodynamics and less body stress reaction.