丙泊酚复合不同镇痛药用于内镜下经胰胆管造影术的临床研究

目的观察丙泊酚复合芬太尼、舒芬太尼、布托啡诺、氟比洛芬酯用于内镜下经胰胆管造影(ERCP)术麻醉时对患者的影响。方法 250例ASAⅠ或Ⅱ级拟行ERCP术患者,排除手术时间短于5min和长于60min的患者,随机均分为五组,丙泊酚分别复合芬太尼(A组)、舒芬太尼(B组)、布托啡诺(C组)、氟比洛芬酯(D组)和生理盐水(E组)进行麻醉。观察并记录不同时点的生命体征、术中体动、丙泊酚的诱导和维持用量、麻醉苏醒时间、患者对麻醉的满意度等指标。结果术后患者对麻醉的舒适满意度均较高;A、B、C、D组患者丙泊酚诱导和维持剂量均少于E组(P<0.05);A组和B组丙泊酚诱导后即刻及手术开始后2minRR减慢明显(P<0.05);E组术中体动多于A、B、C、D组(P<0.05);D组有呃逆现象,明显多于A、B、C、E组(P<0.05)。结论五组患者术后对麻醉的舒适满意度均较高,上述五种麻醉方法均可用于ERCP术静脉全身麻醉。复合使用镇痛药后,丙泊酚诱导和维持剂量明显减少,术中体动减少。其中布托啡诺麻醉更加平稳。

The clinic application of propofol combined with different analgesics in patients of ERCP

Objective To observe the effects of propofol combined with fentanyl, sufentanil, butorphanol and flurbiprofen in the patients with endoscopic retrograde cholangiopanereatography (ERCP) operations.Methods Two hundreds and fifty ASA Ⅰ or Ⅱ patients with ERCP operations (time between 5-60 minutes) were given with propofol combined analgesics, they were randomly devided into five groups. Propofol combined with fentanyl (group A),sufentanil (group B),butorphanol (group C),flurbiprofen(group D),flurbiprofen saline(group E). Blood pressure (BP), heart rate (HR) and body activity, the consumption of propofol for induction and maintenance, recovery time and the comfort level of anesthesia were recorded.Results The comfort level of anesthesia was relatively great and had no differences in each group. Compared with group E, the consumption of propofol for Induction and maintenance in rest groups were all drop obviously (P<0.05). Respiratory depression of group A and B were more obvious than other groups (P<0.05). Body activity of group E was more than other groups (P<0.05). The hiccough in group D was more than other groups (P<0.05).Conclusion All five group can be used for ERCP operation and get comfort level of anesthesia. The consumption of propofol for Induction and maintenance are drop obviously in groups that combined with analgesics. The butorphanol group has more stable anesthesia, which seems to be better for ERCP operation.