老年患者无痛内镜下逆行性胰胆管造影术不良反应及其危险因素分析

Adverse reactions of painless endoscopic retrograde cholangiopancreatography in elderly patients and its risk factors

目的探讨老年患者无痛内镜下逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)的主要不良反应及其发生的危险因素。方法静脉麻醉辅助下行ERCP诊治的老年患者126例,观察ERCP围术期血压、心率、呼吸频率、血氧饱和度(blood oxygen saturation,SpO2)等变化以及不良反应发生情况;采用多因素logistic回归分析主要不良反应发生的危险因素。结果126例患者ERCP术中收缩压[(107.2±10.6)mm Hg]、SpO2[(89.70±0.38)%]均较术前[(120.8±12.5)mm Hg、(98.80±0.56)%]明显降低(P<0.05),术前、术中及术后舒张压、心率、呼吸频率比较差异均无统计学意义(P>0.05);术中并发低氧血症(SpO2<90%)47例(37.3%),血压下降22例,心动过缓3例,恶心呕吐及呛咳各1例;多因素logistic回归分析结果显示,年龄≥80岁(OR=5.309,95%CI:1.987~14.186,P=0.000)、吸烟≥10支/d且30a以上(OR=5.447,95%CI:2.075~14.300,P=0.000)、饮酒≥40g/d且20a以上(OR=3.563,95%CI:1.183~10.731,P=0.000)、体质量指数≥30kg/m2(OR=23.833,95%CI:2.296~191.702,P=0.000)、合并慢性阻塞性肺疾病(OR=8.308,95%CI:3.162~21.824,P=0.000)、丙泊酚用量≥280mg(OR=3.773,95%CI:1.708~8.336,P=0.000)、操作时间≥2h(OR=4.993,95%CI:2.117~11.777,P=0.000)是老年患者无痛ERCP发生低氧血症的危险因素。结论低氧血症是老年患者无痛ERCP术中的主要不良反应,高龄(≥80岁)、长期大量吸烟(≥10支/d且在30a以上)、长期大量饮酒(≥40g/d且在20a以上)、高体质量指数(≥30kg/m2)、合并慢性阻塞性肺疾病、丙泊酚用量大(≥280mg)、操作时间长(≥2h)是其发生的危险因素。

Objective To explore the adverse reactions of painless endoscopic retrograde cholangiopancreatography(ERCP)in elderly patients and its risk factors.Methods A total of 126 elderly patients received painless ERCP under intravenous anesthesia.The blood pressure,heart rate,respiratory rate,blood oxygen saturation(SpO2)during operation of ERCP,and the adverse reactions were observed.Multivariate logistic regression was used to analyze the risk factors for major adverse events.Results The blood systolic pressure((107.2±10.6)mm Hg)and SpO2((89.70±0.38)%)in 126 patients during ERCP were significantly lower than those before ERCP((120.8±12.5)mm Hg,(98.8±0.56)%)(P<0.05).There were no significant differences in blood diastolic pressures,heart rates and respiratory rates before,during and after ERCP(P>0.05).The adverse reactions included hyoxemia(SpO2<90%)in47patients(37.3%),drop of blood pressure in 22 patients,bradycardia in 3patients,nausea and vomiting in 1patient,and choking cough in 1patient.Multivariate logistic regression analysis showed the age≥80years(OR=5.309,95%CI:1.987-14.186,P=0.000),the average daily smoking ≥10 cigarettes for >30 years(OR=5.447,95%CI:2.075-14.300,P=0.000),the average daily drinking≥40g for>20years(OR=3.563,95%CI:1.183-10.731,P=0.000),BMI ≥30 kg/m2(OR=23.833,95%CI:2.296-191.702,P=0.000),COPD(OR=8.308,95%CI:3.162-21.824,P=0.000),propofol dosage ≥280mg(OR=3.773,95%CI:1.708-8.336,P=0.000)and operation lasting time ≥2 h(OR=4.993,95%CI:2.117-11.777,P=0.000)were the major risk factors for hyoxemia.Conclusion Hyoxemia is the major adverse reaction druing painless ERCP in elderly patients.The old age(≥80years)heavy smoking(average daily smoking≥10cigarettes for>30years),alcohol overtaking(average daily drinking≥40g for>20years),overweight(BMI≥30kg/m2),COPD,large dose of propofol(≥280mg)and long operation lasting time(≥2h)are the major risk factors for hyoxemia.