摘要
目的研究单独持续输注瑞芬太尼用于高龄患者内镜逆行胰管造影术（endoscopicretrogradecholangiopancreat—ic，ERCP）患者清醒镇静的临床效果和安全性。方法选择89例ASAI～Ⅲ级、年龄70～89岁拟在清醒镇静下实施ERCP的患者，首先以0．2μg/（kg·nlin）速率持续输注瑞芬太尼5rain，手术开始后减为0．15μg（kg·min），未复合其他麻醉药物。观察患者麻醉前（T0）、手术开始即刻（T1）、手术开始后5min（T1）、和10min（T3）以及术毕（rr4）时血压、心率、呼吸频率、、血氧饱和度（SpO2）、脑电双频指数（BIS）以及术后改良Aldrete镇静评分、操作者满意度评分和不良反应发生情况，并记录手术操作时间和麻醉时间。结果与麻醉诱导前基础值相比较，患者在T2时的血压明显升高，心率在T1、T2、T3、T4时升高显著，SpO2值T4时降低明显，BIS值彳FT1、T2、T3和T4时均明显降低。所有患者均顺利完成操作，操作过程中5例患者血氧饱和度降至90％以下，无1例需要面罩辅助通气或气管插管发生。插入十二指肠镜时发生恶心5例，取石操作中引起轻微疼痛但能忍受的6例，疼痛评分小于3分。8例对镜干入口和取石操作无记忆，19例对镜干入口有记忆，62例对镜干入口和取石操作都存在记忆。术毕取出镜干时9例处于睡眠状态，其他患者均清醒；术后恶心、呕吐的25例，操作者满意度评分为97．1±2．8。结论单独持续输注瑞芬太尼用于高龄ERCP患者清醒镇静可获得满意的麻醉效果，且安全性好。
Objective To study the clinical efficacy and safety of remifentanil infusion alone for conscious sedation during ER- CP for elderly patients. Methods Eighty - nine patients, ASA physical status I -III, aged 70 - 89 years, scheduled for ERCP were in- fused remifentanyl continuously at a rate of 0.2 μg/（ kg · min） for 5 rain before operation, and decreased to 0. 15 p.g/（ kg · min） after operation; other drugs were not given. Blood pressure, heart rate, respiratory rate, oxygen saturation, bispectral index during operation were recorded before anesthetic induction（ T0 ）, at beginning of operation（ T1 ） ,5 min after operation（ T2 ）, 10 min after operation（ T3 ） and at end of operation（ T4 ）. The Modified Aldrete scores, operator satisfaction scores and side effects were observed after operation,operation time and anesthesia time were also recorded. Results Compared with preinduction values ,blood pressures at T2 were significantly high, heart rates at T1 ,T2 ,T3 and T4 were significantly high, SpO2 values at T4 were significantly low,BIS at T1 ,T2 ,T3 and T4 were significantly low. Uncontrolled agitation and movement during sedation did no occmT in both groups. Oxggensaturation of 〈 90% was observed in 5 patients, no intubation and face mask ventilation were required. During insertion of duodenoscopy, nausea occurred in 5 patients,5 patients felt slight pain during stone extraction action. Eight patients were forgot the insertion of duodenoscope and stone extraction, 19 pa- tients remembered the insertion of duodenoscope ,62 patients remembered both actions above. 9 patients were asleep at the end of opera- tion,the other patients were awaken. The operator satisfaction scores were 97.1 ±2.8. Conclusions The continuous remifentanil infusion alone for conscious sedation during ERCP for elderly patients shows satisfactory anesthesia effect and safety.
出处
《武警医学》
CAS
2013年第11期929-932,共4页
Medical Journal of the Chinese People's Armed Police Force
基金
中华医学会麻醉学分会力邦麻醉基金课题(CSA2012LB011)
