右美托咪啶复合丙泊酚靶控输注在ERCP诊疗麻醉中的应用

目的评价右美托咪啶复合丙泊酚靶控输注在内镜逆行胰胆管造影(ERCP)检查取石术麻醉中的有效性和安全性。方法麻醉下行ERCP患者76例,随机分为两组,右美托咪啶复合丙泊酚靶控输注组38例(D组),靶控输注丙泊酚组38例(P组)。观察输注右美托咪啶前(T0)、诱导入睡(T1)、插镜(T2)、套石(T3)、退镜(T4)、睁眼(T5)时的HR、MAP、RR、SpO2,所需丙泊酚浓度、苏醒时间、不良反应发生率、术中镇静评分及术后患者满意度。结果 P组T1时点MAP、RR较T0时点显著下降(P<0.01),组间比较P组T1时点MAP、RR较D组T1时点下降(P<0.05);D组T1～T3时点HR较T0时点下降(P<0.05或P<0.01)。P组丙泊酚所需浓度明显高于D组(P<0.01),D组患者呼吸抑制、术中体动发生率低于P组(P<0.05),D组镇静评分优于P组(P<0.05),D组患者心动过缓的发生率高于P组(P<0.05),两组患者苏醒时间、术后恶心呕吐差异无统计学意义(P>0.05)。结论 ERCP诊疗麻醉中右美托咪啶复合丙泊酚靶控输注可以提供良好的镇静,节俭丙泊酚的用量、无明显的呼吸抑制,不影响患者的清醒。是一种安全、有效的麻醉方法。

Effect of Intravenous Dexmedetomidine Combined with Propofol Using Target-controlled Infusion(TCI) in Endoscopic Retrograde Cholangiopancreatography(ERCP) Anesthesia

Objective To evaluate the efficacy and safety of intravenous dexmedetomidine combined with propofol using target-controlled infusion(TCI) in endoscopic retrograde cholangiopancreatography(ERCP) anesthesia.Methods Seventy six patients undergoing ERCP were randomly divided into two groups :dexmedetomidine combined with propofol using target-controlled infusion(TCI) group(group D,n=38) and propofol using target-controlled infusion(TCI) group(group P,n=38).The HR,MAP,RR and SpO2were detected at the following 6 time points:before infusion of dexmedetomidine(T0),after-induction(T1),inserting endoscope(T2),hitching-up stone(T3),withdrawing endoscope(T4),opening eyes(T5).The plasma concentration of propofol,awakening time,adverse events incidence,intraoperative sedative score and postoperative satisfaction degree of the patients were recorded.Results Compared with T0,MAP and RR were significantly decreased at T1 in group P(P<0.01).HR was significantly decreased at T1-T3 in group D(P<0.05 or P<0.01).Compared with group D,MAP and RR were significantly decreased at T1 in group P(P<0.05).The plasma concentration of propofol in group P was significantly higher than group D(P<0.01).There was less incidence of respiratory depression and intraoperative restlessness in group D than group P(P<0.05).Group D had better sedative scores than group P(P<0.05).There was higher incidence of bradycardia in group D than group P(P<0.05).There was no statistical significance in the awakening time and the incidence of postoperative nausea and vomitting between the two groups(P>0.05).Conclusion Dexmedetomidine combined with propofol using target-controlled infusion(TCI) in endoscopic retrograde cholangiopancreatography(ERCP) is safe and available,which can provide better sedation,less consumption of propofol and less incidence of respiratory depression without influencing the awakening of patients.