两种异丙酚静脉麻醉方法用于内窥镜逆行胰胆管造影的比较  

Comparison of Two Propofol Anesthesia Methods in Endoscopic Retrograde Cholangiopancreatography

作　　者：叶庆明[1] 辜雄军[1] 张银山[1] 黄宝胜[1] 

机构地区：[1]广东医学院附属南山医院麻醉科,深圳518052

出　　处：《中国现代手术学杂志》2014年第5期387-389,共3页Chinese Journal of Modern Operative Surgery

基　　金：2010年度深圳市南山区科技研发资金资助项目;编号:南科卫(201024)号

摘　　要：目的比较两种异丙酚静脉麻醉方法（靶控输注与恒速输注）在内窥镜逆行胰胆管造影（endoscopic retrograde cholangiopancreatography，ERCP）的临床应用。方法拟行ERCP的患者40例，ASAⅠ～Ⅱ级，随机分为靶控组与恒速组（n=20）。靶控组采用Marsh模式，异丙酚血药浓度始于4．0μg／ml；恒速组首剂异丙酚2mg／kg静注后以10mg／（kg·h）持续静脉泵人，根据麻醉深浅调节血药浓度或泵注速度。监测血压、心率、心电图、脉搏血氧饱和度及血气等生命体征，比较两组的麻醉效果、异丙酚用药量与术毕清醒时间等。结果两组麻醉效果均可靠，靶控组异丙酚血药浓度波动于3．0～5．5μg／ml，恒速组异丙酚静注速度波动于6～11 mg／（kg·h）。两组的异丙酚用药量无统计学差异（P〉0．05），恒速组的术毕清醒时间短于靶控组（P〈0．01）。靶控组2例、恒速组1例，因呼吸抑制需面罩加压吸氧。两组患者术中PaCO2及PaO2较术前均明显升高（P〈0．01），术毕恢复正常。结论无插管的异丙酚静脉麻醉，靶控输注或恒速输注均可用于ERCP术，且恒速输注的术毕清醒时间比靶控输注短。Objective To compare the effect of propofol anesthesia by target controlled infusion （TCI） and by constant speed infusion（CSI） for endoscopic retrograde cholangiopancreatography （ERCP）. Methods 40 patients underwent ERCP with ASA grade Ⅰ to Ⅱ were divided into two groups randomly （ n = 20 ）. TCI group was performed propofol anesthesia by TCI with 4.0 μg/ml of incipient concentration. The CSI group was carried out propofol anesthesia by constant speed infusion with 10 mg/ （ kg·h） propofol pumping intravenously following 2 mg/kg intravenous injection. Plasma concentration and pumping rate of propofol were adjusted according to anesthesia depth. The BP, HR, ECG, SpO2 and blood-gas analysis were monitored, and anesthesia effects, propofol consumption and awaking time were recorded and compared between two groups. Results Anesthesia effects of both groups were good for ERCP. Plasma concentration of propofol ranged from 3.0 to 5.5 μg/ml in TCI group. Pumping rate of propofol ranged from 6 to 11 mg/（ kg·h） in CSI group. There was no statistic difference in propofol consumption between two group（P 〉 0.05）, but the awake time of CSI group was shorter than that of TCI group（P 〈0. 01 ）. Two cases in TCI group and one case in CS group were applied mask oxygenation due to respiratory depression. Both PaCO2 and PaO2 of intra-operation were obviously increased than those of pre-operation（ P 〈 0. 01 ）, and were returned to normal soon postoperatively in both two groups. Conclusion Non-endotracheal intubation anesthesia of propofol, by TCI or by CSI can be achieved reliable anesthesia result for ERCP, while the method of CSI has shorter awaking time.

关 键 词：胰胆管造影术 内窥镜逆行 二异丙酚 麻醉 静脉 

分 类 号：R614[医药卫生—麻醉学]