靶控输注丙泊酚复合舒芬太尼在老年患者逆行胰胆管造影术中的应用

目的观察靶控输注丙泊酚在老年患者ERCP中的安全性。方法 60例ASAⅠ～Ⅱ级患者随机分成2组,恒速组(Ⅰ组,n=30例)和TCI组(Ⅱ组,n=30例)。Ⅰ组按2～4 mg/kg手控匀速推注丙泊酚,待患者睫毛反射消失后,接恒速泵按1.5～2 mg/kg维持,每次增减量为0.1 mg/kg。Ⅱ组使用丙泊酚靶控输注泵(Gresby 3500型),以3～4μg/mL浓度进行麻醉诱导,诱导成功后减至诱导量1/2的速度维持,每次增减量为0.5μg/mL。观察比较两组各项指标的变化。结果麻醉维持期间,T1时点恒速组(Ⅰ组)的呼吸频率、指脉搏氧饱和度均低于麻醉前(T0)及靶控组(Ⅱ组)(P<0.05)。两组病例在麻醉诱导时间、手术时间、丙泊酚总用量以及舒芬太尼总用量方面差异无统计学意义。但靶控组(Ⅱ组)意识恢复时间明显短于恒速组(Ⅰ组)(P<0.05)。两组有6例(Ⅰ组5例,Ⅱ组1例)出现呼吸抑制,经托起下颌或适当改变体位后缓解。结论靶控输注丙泊酚复合舒芬太尼用于老年人麻醉过程平稳,不良反应轻,麻醉安全性和可控性高。

Target-controlled infusion of propofol combined with sufentanil in elderly patients with ERCP

Objective To observe the safety of target-controlled infusion of propofol in elderly patients with ERCP.Methods 60 cases of ASA Ⅰ ~ Ⅱ grade were randomly divided into two groups:constant speed group(group Ⅰ,n=30)and TCI group(group Ⅱ,n=30).Group Ⅰ was given uniform bolus of propofol 2~4 mg/kg by constant speed with hands,after the patients′ eyelash reflex disappeared,the constant speed pump controlled 1.5~2 mg/kg maintenance,the increasing/decreasing amount was 0.1 mg/kg each time.Group Ⅱ was given propofol target-controlled infusion pump(Gresby 3500 type),anesthesia was induced with 3~4 μg/mL,induction was reduced of 1/2 to maintain after the success of induction,the increasing/decreasing amount was 0.5 μg/mL each time.The indicators of the two groups were compared.Results During maintenance of anesthesia,the respiratory rate,the pulse oxygen saturation of the T1 point of group I were lower than those before treatment(T0)and those of group Ⅱ(P<0.05).Induction of anesthesia time,operative time,the total volume of propofol and sufentanil of the two groups had no significant difference.Consciousness recovery time of group Ⅱ was significantly shorter than that of groupⅠ(P<0.05).There were 6 cases(5 cases in groupⅠ,1 case in group Ⅱ)of respiratory depression,and they were mitigated through the hold of jaw.Conclusion Target-controlled infusion of propofol in elderly patients with ERCP is smooth with mild adverse reactions and high safety and controllability.