纳布啡在急诊内镜逆行胰胆管造影术麻醉中的安全性和有效性研究  

Safety and efficacy of nabulphine in emergency endoscopic retrograde cholangiopancreatography anesthesia

作　　者：喻乐 徐林[1] 戚忠 王加芳[1] 陈治军 YU Le;XU Lin;QI Zhong;WANG Jiafang;CHEN Zhijun(Department of Anesthesiology,the First Hospital of Wuhan,Wuhan,430020,China)

机构地区：[1]武汉市第一医院麻醉科

出　　处：《临床急诊杂志》2019年第12期967-970,共4页Journal of Clinical Emergency

摘　　要：目的:观察纳布啡复合丙泊酚在急诊内镜逆行胰胆管造影(ERCP)术麻醉中的安全性和有效性。方法:120例急性梗阻性胆管炎行急诊ERCP术的患者随机分为两组,舒芬太尼复合丙泊酚静脉麻醉组(PS组,60例)和纳布啡复合丙泊酚静脉麻醉组(PN组,60例)。PS组患者先静脉给予舒芬太尼(0.1μg/kg),PN组患者先给予纳布啡(0.15 mg/kg),3 min后均再给予丙泊酚(1~2 mg/kg)行麻醉诱导,待患者睫毛反射消失后开始ERCP手术操作。观察记录两组患者围术期各时间点(T0:麻醉诱导前;T1:意识和睫毛反射消失后;T2:术中;T3:苏醒后)的MAP、HR和SpO2;记录两组患者围术期低血压、心动过缓、呼吸抑制、呛咳、体动和恶心呕吐的发生情况及苏醒时间;记录术后患者和术者对麻醉的满意度。结果:T1时间点PS组患者SpO2低于T0时间点,差异有统计学意义(P<0.05),T1时间点PN组患者SpO2与T0时间点相比,差异无统计学意义(P>0.05);T1时间点PS组患者SpO2低于PN组,差异有统计学意义(P<0.05);与PS组相比,PN组患者苏醒时间、术中呼吸抑制、呛咳及术后恶心呕吐的发生率均较低(均P<0.05)。结论:与舒芬太尼复合丙泊酚相比较,纳布啡复合丙泊酚的患者苏醒时间更短,术中不良反应发生率更低,患者和术者的麻醉满意度均较高,能够为急诊ERCP术提供安全有效的麻醉效果。Objective:To investigate the safety and efficacy of nabulphine in emergency endoscopic retrograde cholangiopancreatography(ERCP)anesthesia.Method:A total of 120 patients undergoing emergency ERCP operations were given with propofol combined analgesics,they were randomly divided into two groups.Patients in the PS group were intravenously given sufentanil(0.1μg/kg),patients in the PN group were first given nalbuphine(0.15 mg/kg),and then were given propofol(1-2 mg/kg)for anesthesia induction after 3 minutes.ERCP surgery was started after the patients’eyelash reflex disappeared.MAP,HR and SpO2 of the two groups of patients at each time point during the perioperative period were observed and recorded.The incidence and recovery time of perioperative hypotension,bradycardia,respiratory depression,cough,body movement,nausea and vomiting were recorded.Result:In T1,the SpO2 of PS group was lower than T0,and the difference was statistically significant(P<0.05).In T1,the SpO2 of PN group was no statistical difference compared with T0(P>0.05).In T1 time the SpO2 of PS group was lower than PN group,and the difference was statistically significant(P<0.05);Compared with PS group,the recovery time,incidence of intraoperative respiratory depression,choking cough and postoperative nausea and vomiting in PN group was lower(P<0.05).Conclusion:Compared with sufentanil combined with propofol,patients with nbuphine combined with propofol have shorter recovery time and lower incidence of intraoperative adverse reactions,and good satisfaction with anesthesia in both patients and operators,which can provide safe and effective anesthesia effect for emergency ERCP.

关 键 词：内镜逆行胰胆管造影 纳布啡 镇痛 舒适化医疗 安全性 有效性 

分 类 号：R614.2[医药卫生—麻醉学]