丙泊酚联合艾司氯胺酮在内镜逆行胰胆管造影术中镇静有效性及安全性  

Efficacy and safety of propofol combined with esketamine for sedation during endoscopic retrograde cholangiopancreatography

作　　者：刘文超 梁淑娟[1] 王现雷 LIU Wenchao;LIANG Shujuan;WANG Xianlei(Department of Anesthesiology,First Hospital of Qinhuangdao,Qinhuangdao 066099,Hebei Province,China)

机构地区：[1]秦皇岛市第一医院麻醉科,河北秦皇岛066099

出　　处：《世界临床药物》2022年第9期1124-1129,共6页World Clinical Drug

基　　金：河北省卫生健康委员会资助项目(202004A064)。

摘　　要：目的 研究丙泊酚联合艾司氯胺酮在内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)中镇静的有效性及安全性。方法 选择2020年1月至2021年1月于秦皇岛市第一医院接受ERCP的患者100例进行前瞻性研究,按照随机数表法分为A组(采用丙泊酚联合艾司氯胺酮静脉麻醉)及B组(采用丙泊酚联合芬太尼静脉麻醉),各50例。比较两组镇静状态评分;记录两组麻醉前(T0)、完成诱导后(T1)、经口腔进镜(T2)、手术结束退镜后(T3)及苏醒时(T4)的心率、平均动脉压(mean arterial pressure,MAP)及血氧饱和度(pulse oxygen saturation,SpO_(2))。对比两组操作时间、苏醒时间、丙泊酚总用量及不良反应发生情况。结果 A组镇静状态评分明显优于B组(P <0.05)。时间与方法在心率、MAP及SpO_(2)水平变化上主效应均显著(P <0.05);时间与方法在心率、MAP及SpO_(2)水平变化上不存在交互效应(P> 0.05)。T4时A组心率高于B组(P <0.05);T3、T4时A组MAP、SpO_(2)高于B组(P <0.05)。A组苏醒时间较B组短,丙泊酚用量少于B组(P <0.05)。A组不良反应总发生率低于B组(P <0.05)。结论 丙泊酚联合艾司氯胺酮应用于ERCP术中麻醉能提供有效的镇静镇痛作用,在维持术中血流动力学稳定方面具有优势,且能减少麻醉药物用量,缩短苏醒时间,降低不良反应发生率,是一种安全、有效的麻醉方案。Objective To study the efficacy and safety of propofol combined with esketamine for sedation during endoscopic retrograde cholangiopancreatography(ERCP).Methods A total of 100 patients who received ERCP in first hospital of Qinhuangdao from January 2020 to January 2021 were selected for prospective study.The patients were divided into group A(intravenous anesthesia with propofol combined with esketamine) and group B(intravenous anesthesia with propofol combined with fentanyl) according to the random number table method,50 cases in each group.The scores of sedation were compared between the two groups.Heart rate,mean arterial pressure(MAP) and blood oxygen saturation(SpO_(2)) were recorded before anesthesia(T0),after induction(T1),through oral endoscopy(T2),after surgery(T3) and after recovery(T4) in both groups.The operation time,recovery time,total dosage of propofol and the incidence of adverse reactions were compared between the two groups.Results The sedation score of group A was significantly better than that of group B(P<0.05).The main effects of time and method on heart rate,MAP and SpO_(2) levels were significant(P<0.05).There was no interaction effect between time and method on heart rate,MAP and SpO_(2) levels(P>0.05).The heart rate of group A was higher than that of group B at T4(P<0.05).MAP and SpO_(2) in group A were higher than those in group B at T3 and T4(P<0.05).The time of recovery in group A was shorter than that in group B,and the dosage of propofol in group A was less than that in group B(P<0.05).The total incidence of adverse reactions in group A was lower than that in group B(P<0.05).Conclusion Esketamine combined with propofol in ERCP anesthesia can provide effective sedative and analgesic effect,has advantages in maintaining intraoperative hemodynamic stability,and can reduce the dosage of anesthetic drugs,shorten the time to wake up,and reduce the incidence of adverse reactions,which is a safe and effective anesthesia program.

关 键 词：丙泊酚 艾司氯胺酮 内镜逆行胰胆管造影术 安全性 

分 类 号：R971.2[医药卫生—药品]