阿芬太尼复合丙泊酚镇静麻醉在治疗性ERCP术中的临床疗效分析

Clinical efficacy analysis of alfentanil combined with propofol sedation anesthesia in therapeutic ERCP

目的探究阿芬太尼复合丙泊酚镇静麻醉在治疗性经内镜逆行性胰胆管造影(ERCP)术中的临床疗效。方法选取2022年1月至2023年4月于石河子大学第一附属医院消化内科住院且行治疗性ERCP术,符合美国麻醉医师协会Ⅰ~Ⅱ级的患者200例为研究对象,按随机数表法分为两组,每组各100例。两组术前30 min肌内注射地西泮10 mg、哌替啶50 mg及山莨菪碱10 mg,对照组在患者清醒状态下手术,试验组缓慢静脉注射阿芬太尼25~75 mcg/kg和丙泊酚1.5~2 mg/kg诱导镇静后手术,术中持续静脉泵入丙泊酚和阿芬太尼。比较两组患者手术前后血流动力学情况[心率(HR)、收缩压(SBP)、舒张压(DBP)、血氧饱和度(SpO2)]、完成手术所需时间、镇静镇痛效果[镇静采用Ramsay评分(1~6分),镇痛采用疼痛视觉模拟评分(VAS)]、术前及术后认知功能[简易精神状态量表检查(MMSE)评分]变化及不良反应发生率情况。结果诱导前,两组HR、SBP、DBP、SpO2值比较,差异无统计学意义(P>0.05);置镜时,试验组HR、SBP、DBP值均低于对照组、SpO2值高于对照组,差异有统计学意义(P<0.05)。试验组完成手术所需时间明显少于对照组,差异有统计学意义(P<0.05);术中对照组Ramsay评分明显低于试验组,术后对照组VAS评分明显高于试验组,差异有统计学意义(P<0.05)。麻醉前,两组MMSE评分比较,差异无统计学意义(P>0.05);术后2 h,两组MMSE评分均降低,但组间比较差异无统计学意义(P>0.05)。试验组总不良反应发生率(8.00%)与对照组总不良反应发生率(25.00%)比较,差异有统计学意义(P<0.05)。结论阿芬太尼复合丙泊酚镇静麻醉在治疗性ERCP术中具有较好的临床疗效,能够有效地维持血流动力学水平稳定,明显缩短手术时间,镇静镇痛效果及安全性较好,且不良反应发生率低,值得在临床进一步推广应用。

Objective To explore the clinical efficacy of alfentanil combined with propofol sedation anesthesia in therapeutic endoscopic retrograde cholangiopancreatography(ERCP).Methods A total of 200 patients admitted to the Department of Gastroenterology,the First Affiliated Hospital of Shihezi University from January 2022 to April 2023 who underwent therapeutic ERCP and were eligible for American Society of Anesthesiology gradeⅠ-Ⅱwere selected as the study subjects.They were divided into two groups,with 100 patients in each group,using a random number table method.Two groups were intramuscularly injected with 10 mg of diazepam,50 mg of pethidine,and 10 mg of anisodamine 30 minutes before surgery.The control group underwent surgery while the patient was conscious.The experimental group received slow intravenous injection of 25-75 mcg/kg of afentanil and 1.5-2 mg/kg of propofol to induce sedation before surgery.During the surgery,propofol and afentanil were continuously pumped intravenously.The hemodynamics(heart rate[HR],systolic blood pressure[SBP],diastolic blood pressure[DBP],blood oxygen saturation[SpO2])before and after surgery,the time required to complete the surgery,the sedation and analgesia effects(Ramsay score[1-6 points]was used for sedation,visual analogue scale[VAS]was used for analgesia[0-10 points]),the changes in cognitive function(mini mental state examination[MMSE]score)before and after surgery,and the incidence of adverse reactions were compared between two groups of patients.Results Before induction,there was no significant difference in HR,SBP,DBP and SpO2 between the two groups(P>0.05).When the surgery begin,the values of HR,SBP and DBP in the experimental group were lower than those in the control group,and the value of SpO2 was higher than that in the control group,with statistical significance(P<0.05).The time required to complete the surgery in the experimental group was significantly shorter than that in the control group,with statistical significance(P<0.05).The Ramsay score of the control group was significantly lower than that of the experimental group during surgery,and the VAS score of the control group was significantly higher than that of the experimental group after surgery,with statistical significance(P<0.05).There was no significant difference in MMSE scores between the two groups before anesthesia(P>0.05).Two hours after surgery,the MMSE scores of both groups decreased,but there was no significant difference in MMSE scores between the two groups(P>0.05).The total incidence of adverse reactions in the experimental group(8.00%)was significantly different from that in the control group(25.00%)(P<0.05).Conclusion Afentanil combined with propofol has a good clinical efficacy in the therapeutic ERCP,which can effectively maintain the stable hemodynamic level and significantly shorten the surgery time.The sedative and analgesic effect and safety are good,and the incidence of adverse reactions is low,which is worthy of further promotion and application in clinic.