微创医学

目的探讨靶控输注(target controlled infusion,TCI)依托咪酯复合瑞芬太尼静脉泵注用于老年人内窥镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)的麻醉效果。方法拟行ERCP术的老年患者40例,年龄≥65岁,随机分为靶控输注依托咪酯组(E组)和恒速输注丙泊酚组(P组),每组20例。记录术中不同时间点的平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2)、呼吸频率(RR)、Narcotrend指数(NI),并记录术中体动、呛咳和呼吸抑制等不良反应的发生情况。结果两组患者T2时MAP和HR均低于T1,但E组下降的幅度比P组小,且在T2、T3、T4、T5时无明显变化;P组诱导后各时间点的RR和SpO2均低于诱导前,且低于同时间点的E组;两组患者的麻醉和苏醒时间无明显差异(P>0.05);E组体动或呛咳和SpO2<90%的发生率明显低于P组(P<0.05)。结论靶控输注(TCI)依托咪酯复合瑞芬太尼静脉泵注麻醉用于老年患者ERCP术的血流动力学稳定,术中不良反应少,是一种安全有效的麻醉方法。

Objective To explore the effects of target controlled infusion( TCI) of etomidate combined remifentanil anesthesia in gerontal patients undergoing endoscopic retrograde cholangiopancreatography ( ERCP) ． Methods A total of 40 old patients( ≥65y) scheduled for ERCP were randomly divided into two groups: TCI etomidate group ( group E) and intravenous injection propofol group ( group P) ． The BP，HR， SpO2 ，RR and NI were recorded at the different time． And side effects during operations like body movement， cough，or respiratory inhibition were also recorded． Results The MAP and HR of two groups at T2 were lower than at T1，with the latitude was less in group E， and there were no significant changes at T2 ，T3 ，T4 ，T5 ; The RR and SpO2 at the every time points of after induced were lower than before anesthesia in group P， and lower than group E at the same time points; there were no significant differences between two groups in recovery time ( P ＞ 0． 05) ，but the rate of body movement or cough or SpO2 was apparently lower in group E than in group P ( P ＜ 0． 05) ． Conclusions TCI etomidate combined with remifentanil anesthesia is one reasonable anesthesia for ERCP in old patients，for its stabile haemodynamics and less side effects．