清醒镇静与静脉麻醉在内窥镜逆行胰胆管造影术治疗肝外胆管结石中的比较研究

目的 探讨清醒镇静与静脉麻醉在内窥镜逆行胰胆管造影术（ERCP）治疗肝外胆管结石中的安全性、有效性.方法 将100例采用ERCP治疗的肝外胆管结石患者按入组顺序进行编号,50例奇数者采用静脉麻醉（静脉麻醉组）,给予静脉注射丙泊酚；50例偶数者采用清醒镇静（清醒镇静组）,给予肌肉注射地西泮及哌替啶.观察两组患者术中反应（拔镜行为、自行体位改变）、生命体征变化情况、操作时间、取石成功率及并发症发生情况.结果 清醒镇静组术中拔镜行为、自行体位改变发生率明显高于静脉麻醉组24％（12/50）比2％（1/50）、18％（9/50）比0],差异均有统计学意义（P＜0.01）.两组用药后5min平均动脉压、心率均较术前明显降低,差异有统计学意义（P＜0.05）；进镜后10 min、术后清醒时与术前比较差异无统计学意义（P＞0.05）；两组脉搏血氧饱和度比较差异均无统计学意义（P＞0.05）.两组取石成功率均为98％（49/50）.静脉麻醉组操作时间明显短于清醒镇静组（38.2±6.3） min比（49.1±9.9） min],差异有统计学意义（P＜0.01）.两组并发症发生率比较差异无统计学意义（P＞0.05）.结论 静脉麻醉和清醒镇静均可用于ERCP治疗肝外胆管结石,但静脉麻醉能明显减轻患者不适,缩短操作时间.

Comparative study of conscious sedation and intravenous anesthesia used to endoscopic retrograde cholangio pancreatiography in treatment of extrahepatic bile duct stones

Objective To evaluate the safety and effectiveness of conscious sedation and intravenous anesthesia used to endoscopic retrograde cholangio pancreatiography （ERCP） in treatment of extrahepatic bile duct stones.Methods A total of 100 cases of extrahepatic bile duct stones patients in treatment of ERCP were encoded by the group order,50 cases of odd used intravenous anesthesia （intravenous anesthesia group）,intravenous injection of propofol; 50 cases of even used conscious sedation （conscious sedation group）,muscle injection of diazepam and pethidine.Intraoperative reaction （extubation behavior,own postural changes）,changes in vital signs,operating time,the success rate of stone and complication were observed in two groups.Results The incidence of intraoperative extubation behavior and own postural changes in conscious sedation group were significantly higher than those in intravenous anesthesia group 24% （12/50） vs.2% （1/50）,18% （9/50） vs.0],and the differences were statistically significant （P 〈 0.01）.The heart rate and mean artery pressure in two groups were decreased at 5 minutes after administration than that before operation,and the difference was statistically significant （P 〈 0.05）,but there was no statistical significance at 10 min after entering the mirror and postoperative awake compared with before operation （P 〉 0.05）.Pulse oxygen saturation between two groups had no statistical significance （P 〉0.05）.The success rate of stone in two groups were 98% （49/50）.Operating time in intravenous anesthesia group was obviously shorter than that in conscious sedation group （38.2 ± 6.3） min vs.（49.1 ± 9.9） min] （P 〈 0.01）.The complications between two groups had no statistical significance （P 〉 0.05）.Conclusion Conscious sedation and intravenous anesthesia can be used to ERCP in treatment of extrahepatic bile duct stones,but intravenous anesthesia can obviously reduce patients discomfort,shorten the operation time.