丙泊酚联合地佐辛在日间经内镜逆行胰胆管造影术麻醉中的应用

目的分析丙泊酚联合地佐辛用于日间经内镜逆行胰胆管造影术(ERCP)麻醉的安全性及有效性。方法选择我院行ERCP患者566例,男292例,女274例,年龄40~70岁,体重40~85kg,ASAⅠ或Ⅱ级,随机分为丙泊酚联合芬太尼组(F组)和丙泊酚联合地佐辛组(D组),每组283例。F组先给予芬太尼100μg,D组给予地佐辛5mg,3min后两组均给予丙泊酚2mg/kg,术中调整丙泊酚用量在3~5mg·kg-1·h-1,维持BIS值在50~55。记录患者丙泊酚总用量、麻醉时间、苏醒时间及术后不良反应(呃逆、呛咳、恶心、呕吐)发生情况;统计术后48h内患者出院情况。结果D组苏醒时间(5.1±1.1)min明显短于F组(5.6±2.5)min(P0.05);D组术后恶心、呕吐发生率(4%和0%)明显低于F组(9%和1%)(P0.05);术后48h内D组出院率(30%)明显高于F组(18%)(P0.05)。结论丙泊酚2mg/kg联合地佐辛5mg/kg应用于ERCP手术血流动力学更稳定,恶心、呕吐发生率低,住院时间短。

Application of propofol combined with dezocine in endoscopic retrograde cholangiopancreatography

Objective To investigate safety and feasibility of propofol combined with dezocine in ambulatory ERCP.Methods Five hundred and sixty-six patients were collected in our hospital in recent two years suffering ERCP were randomly divided into two groups,292 males,274 females, aged from 40 to 70 years,weight from 40 to 85 kg:group F was given fentanyl 100 μg,group D was given dezocine 5 mg;then propofol was given at 2 mg/kg in both two groups in 3 min,continuely at 3-5 mg·kg-1 ·h-1 under BIS value at 50-55.MAP,HR,SpO 2 were observed and compared at five points:before anesthesia induction (T0 ),immediately after induction (T1 ),through the throat in-stantly (T2 ),immediately before the end of operation (T3 ),awakening time (T4 ),comparing the total volume of propofol,recovery time,postoperative complication;the discharge number within 48 hours of the operation was analyzed.Results Shorter recovery time [(1 5.1 ± 1.1 )min vs.(5.6 ± 2.5)min]and less adverse reactions (4% vs.9%,0% vs.1%)occurred in group D than group F (18%)(P <0.05);more patients were discharged within 48 hours in group D (30%)than group F (P <0.05 ).Conclusion Propofol 2 mg/kg combined with dezocine is more suitable for ambulatory surgery about ERCP for its stable circulatory system value,less adverse reactions and shorter hospi-talization time.