艾司氯胺酮联合经鼻高流量湿化氧疗在经十二指肠镜逆行胆胰管造影中的应用  

Application of esketamine combined with high-flow nasal cannula oxygen therapy in endoscopic retrograde cholangiopancreatography

作　　者：刘帆 周东旭 LIU Fan;ZHOU Dongxu(Department of Anesthesiology,Xiangyang Central Hospital,Afiliated Hospital of Hubei University of Ars and Science,Xiangyang,Hubei Province 441201,China)

机构地区：[1]湖北文理学院附属医院(襄阳市中心医院)麻醉科,441201

出　　处：《介入放射学杂志》2022年第7期675-678,共4页Journal of Interventional Radiology

基　　金：国家自然科学基金(81472845)。

摘　　要：目的 探讨艾司氯胺酮联合经鼻高流量湿化氧疗(high-flow nasal cannula oxygen therapy,HFNC)在经十二指肠镜逆行胆胰管造影(endoscopic retrograde cholangiopancreatography, ERCP)中的应用。方法 选择襄阳市中心医院拟行ECRP的患者90例,随机分为A、B、C 3组。A组患者采用丙泊酚+阿芬太尼+鼻导管低流量吸氧,B组患者采用丙泊酚+阿芬太尼+HFNC,C组患者采用丙泊酚+艾司氯胺酮+HFNC。统计3组患者丙泊酚、阿芬太尼或艾司氯胺酮总用量、手术时间、苏醒时间、医生及患者的满意度,记录3组患者入手术室(T1)、麻醉诱导完成后(T2)、手术开始时(T3)、手术开始5 min(T4)、手术结束时(T5)、进入麻醉恢复室时(T6)、进入麻醉恢复室10 min(T7)、进入麻醉恢复室20 min(T8)、出恢复室时(T9)生命体征(HR、MAP、SPO_(2)、 PTCCO_(2))变化。结果 3组患者一般情况、手术时间、苏醒时间、医生及患者的满意度比较,差异均无统计学意义(均P>0.05);C组患者丙泊酚用量明显低于A、B两组,差异有统计学意义(P<0.05);T1时刻3组患者生命体征相比差异无统计学意义,T2-T5时刻A、B两组患者HR、MAP明显低于C组差异有统计学意义(P<0.05),T3-T5时刻A组的PTCCO_(2)明显高于B、C两组,差异均有统计学意义(均P<0.05)。结论 艾司氯胺酮联合HFNC可以减少ERCP手术患者术中丙泊酚用量,不影响患者苏醒时间而且可以减少呼吸循环并发症的发生。Objective To discuss the application of esketamine combined with high-flow nasal cannula oxygen therapy(HFNC) in endoscopic retrograde cholangiopancreatography(ERCP). Methods A total of 90 patients who were planned to receive ECRP were enrolled in this study. The patients were randomly divided into group A(n=30, receiving propofol, alfentanil and nasal catheter low-flow oxygen), group B(n=30,receiving propofol, alfentanil and HFNC), and group C(n=30, receiving propofol, esketamine and HFNC). The total used amount of propofol, alfentanil or esketamine, the time spent for operation, the time of regain consciousness and the satisfaction of doctors and patients were calculated. The vital signs, including HR, MAP,SPO2and PTCCO2, were measured at the following points of time: patient entering the operating room(T1),completion of anesthesia induction(T2), starting surgery(T3), 5 minutes after starting surgery(T4), completion of surgery(T5), patient entering the anesthesia recovery room(T6), 10 minutes after entering the anesthesia recovery room(T7), 20 minutes after entering the anesthesia recovery room(T8) and patient leaving the anesthesia recovery room(T9). The incidence of perioperative adverse reactions, including respiratory depression,bradycardia, tachycardia, hypertension, hypotension, nausea and vomiting, etc. were recorded. Results No statistically significant differences in the patient’s general conditions, the time spent for operation, the time of regain consciousness and the satisfaction of doctors and patients existed between each other among the three groups(P>0.05 in all). The used amount of propofol in group C was remarkably lower than that in group A and group B(P<0.05). There were no statistically significant differences in vital signs measured at T1 between each other among the three groups. HR and MAP measured at T2-T5 in group A and group B were strikingly lower than those in group C(P<0.05). PTCCO2measured at T3-T5 in group A was obviously higher than that in group B and group C, the difference

关 键 词：艾司氯胺酮 高流量湿化氧疗 经十二指肠镜逆行胆胰管造影 

分 类 号：R656[医药卫生—外科学]