环泊酚在无痛内镜逆行胰胆管造影术中的应用效果研究

Application of ciprofol in painless endoscopic retrograde cholangiopancreatography

关键词:  环泊酚  镇静  经内镜逆行胰胆管造影术

Key words:  ciprofol  sedation  endoscopic retrograde cholangiopancreatography

摘要:

目的探究不同剂量环泊酚复合舒芬太尼在无痛内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)中的应用效果。 方法选取因胆总管结石拟行无痛ERCP的患者150例，采用随机数字表法将患者随机分为3组，分别为C组50例、R1组50例、R2组50例。C组采用0.1 μg舒芬太尼联合2 mg/kg丙泊酚诱导，6 mg/(kg·h)丙泊酚术中维持方案；R1组采用0.1 μg/kg舒芬太尼联合0.4 mg/kg环泊酚诱导，1 mg/(kg·h)环泊酚术中维持方案；R2组采用0.1 μg/kg舒芬太尼联合0.5 mg/kg环泊酚诱导，1.5 mg/(kg·h)环泊酚术中维持方案。比较3组镇静成功率、不良事件发生率、血流动力学等指标。结果3组患者麻醉诱导后即刻MOAA/S评分、诱导完成30 s后MOAA/S评分、呛咳发生率、苏醒时间差异无统计学意义（P>0.05）；与C组比较，R1组、R2组体动发生率与镇静成功率差异无统计学意义（P>0.05）；与R1组比较，R2组的体动发生率更低，镇静成功率更高。3组患者心动过缓、呃逆、术后恶心的发生率差异无统计学意义（P>0.05）；与C组比较，R1组低血压发生率更低（P<0.05），R1组、R2组呼吸抑制发生例数更少（P<0.05），R1组、R2组注射痛更少（P<0.05）。3组患者各时间段心率变化无统计学意义（P>0.05）；3组患者进入检查室时、转入苏醒室时平均动脉压差异无统计学意义（P>0.05）；与C组相比，麻醉诱导后R1组、R2组平均动脉压更高（P<0.05），十二指肠乳头插管后R1组平均动脉压更高（P<0.05），手术结束时R1组平均动脉压更高（P<0.05）；与R1组相比，R2组十二指肠乳头插管后平均动脉压较低（P<0.05）。 结论以0.1 μg/kg舒芬太尼联合0.5 mg/kg环泊酚诱导及1.5 mg/(kg·h)环泊酚术中维持方案在无痛ERCP中应用效果较好，兼具了镇静成功率高及不良事件发生率低的优点。

Abstract:

ObjectiveTo investigate the effects and safety of ciprofol in painless endoscopic retrograde cholangiopancreatography. MethodsA total of 150 patients undergoing painless ERCP for common bile duct stones were randomly divided into three groups with 50 cases in each group. Group C received 0.1 μg sufentanil combined with 2 mg/kg propofol for induction，and 6 mg/(kg·h) propofol for maintenance intraoperatively; group R1 received 0.1 μg/kg sufentanil combined with 0.4 mg/kg ciprofol for induction and 1 mg/(kg·h) ciprofol for maintenance; group R2 received 0.1 μg/kg sufentanil combined with 0.5 mg/kg ciprofol for induction and ciprofol 1.5 mg/(kg·h) for maintenance. The number of successful cases of sedation, the number of adverse events and the changes of hemodynamic indexes in the three groups were compared. ResultsThere were no significant differences in MOAA/S score immediately after anesthesia induction and 30 seconds after induction, no significant differences in the incidence of coughing andrecovery time among three groups. Compared with the group R1, the group R2 had a lower incidence of physical movements and a higher success rate of sedation. There was no significant difference in the incidence of bradycardia, hiccups, and postoperative nausea among the three groups. Compared with group C, the incidence of hypotension was lower in the group R1, the number of respiratory depression and the injection pain in the groups R1 and R2 was less. There was no significant difference in heart rate changes among the three groups of patients at each time point.There was no significant difference in mean arterial pressure among the three groups when entering the examination room and when entering the postanesthesia care unit. Compared with group C, the mean arterial pressure of groups R1 and R2 was higher after anesthesia induction; and the mean arterial pressure of group R1 was higher after duodenal papilla intubation and after operation. Compared with the group R1, the mean arterial pressure of the R2 group was lower after duodenal papilla intubation. ConclusionThe regimen of sufentanil 0.1 μg/kg combined with ciprofol 0.5 mg/kg for induction and 1.5 mg/(kg·h) for intraoperative maintenance has a good application effect in painless ERCP, with advantages of high success rate of sedation and low rate of adverse events.