CAJ | 학술논문

目的：研究不同剂量的舒芬太尼在合并心血管疾病患者ERCP术中麻醉效果及安全性。方法111例ASAⅡ~Ⅲ级合并心血管疾病行ERCP术患者,随机分为3组(n=37例)：S1组、S2组、S3组。每组经静脉10min输注右美托咪定0.5μg/kg后分别复合硫酸镁10mg/kg+舒芬太尼0．1μg/kg、0．12μg/kg、0．15μg/kg静脉缓慢注射。随即血浆靶控输注依托咪酯,设定血浆浓度0.5 ug/mL。每组术中采用持续泵注硫酸镁6mg/( kg·h)+依托咪酯靶控血浆浓度0.3~0.5μg/mL维持麻醉。根据BIS 值调整依托咪酯的血浆浓度,维持BIS值于55左右。观察并记录入室麻醉前、诱导后、插镜时、内镜置入十二指肠乳头、苏醒等不同时点平均动脉压( MAP)心率( HR)、心率收缩压乘积( RPP)、血氧饱和度( SpO 2)、及各时点的BIS值。统计手术操作时间、麻醉苏醒及定向力恢复时间和不良反应的发生率。结果所有患者均较顺利完成手术操作。 MAP及HR在插镜时、镜入十二指肠镜乳头开口时S2、S3明显低于S1组,差异有统计学意义( P<0．05)。手术全程S3组心动过缓发生率高于S2组,差异有统计学意义(P<0．05)。 RPP：镜入十二指肠镜乳头开口时S2、S3明显低于S1组,差异有统计学意义(P<0．01)。 BIS：诱导后至镜入十二指肠S3各时点均明显低于S1,差异有统计学意义(P<0．01)；插管时S3<S2<S1,差异有统计学意义(P<0．05),置入十二指肠镜时S3、S2<S1,差异有统计学意义(P<0．05)；SPO2：插镜时S3<S1,差异有统计学意义(P<0．05),镜入十二指肠乳头时 S3<S2、S1,差异有统计学意义(P<0．05)。术中躁动、呛咳发生率S1组明显高于S2、S3组,差异有统计学意义(P<0．05),呼吸抑制发生率S1、S2显著低于S3组(P<0．05),三组患者无术中知晓的发生。结论舒芬太尼复合右美托咪定、硫酸镁在合并心血管疾病患者ERCP手术中,舒芬太尼0．12μg/kg能维持较满意的麻醉深度,术中血流动力学平稳,不良反应发生率少,有良好的安全性。目的：研究不同劑量的舒芬太尼在閤併心血管疾病患者ERCP術中痳醉效果及安全性。方法111例ASAⅡ~Ⅲ級閤併心血管疾病行ERCP術患者,隨機分為3組(n=37例)：S1組、S2組、S3組。每組經靜脈10min輸註右美託咪定0.5μg/kg後分彆複閤硫痠鎂10mg/kg+舒芬太尼0．1μg/kg、0．12μg/kg、0．15μg/kg靜脈緩慢註射。隨即血漿靶控輸註依託咪酯,設定血漿濃度0.5 ug/mL。每組術中採用持續泵註硫痠鎂6mg/( kg·h)+依託咪酯靶控血漿濃度0.3~0.5μg/mL維持痳醉。根據BIS 值調整依託咪酯的血漿濃度,維持BIS值于55左右。觀察併記錄入室痳醉前、誘導後、插鏡時、內鏡置入十二指腸乳頭、囌醒等不同時點平均動脈壓( MAP)心率( HR)、心率收縮壓乘積( RPP)、血氧飽和度( SpO 2)、及各時點的BIS值。統計手術操作時間、痳醉囌醒及定嚮力恢複時間和不良反應的髮生率。結果所有患者均較順利完成手術操作。 MAP及HR在插鏡時、鏡入十二指腸鏡乳頭開口時S2、S3明顯低于S1組,差異有統計學意義( P<0．05)。手術全程S3組心動過緩髮生率高于S2組,差異有統計學意義(P<0．05)。 RPP：鏡入十二指腸鏡乳頭開口時S2、S3明顯低于S1組,差異有統計學意義(P<0．01)。 BIS：誘導後至鏡入十二指腸S3各時點均明顯低于S1,差異有統計學意義(P<0．01)；插管時S3<S2<S1,差異有統計學意義(P<0．05),置入十二指腸鏡時S3、S2<S1,差異有統計學意義(P<0．05)；SPO2：插鏡時S3<S1,差異有統計學意義(P<0．05),鏡入十二指腸乳頭時 S3<S2、S1,差異有統計學意義(P<0．05)。術中躁動、嗆咳髮生率S1組明顯高于S2、S3組,差異有統計學意義(P<0．05),呼吸抑製髮生率S1、S2顯著低于S3組(P<0．05),三組患者無術中知曉的髮生。結論舒芬太尼複閤右美託咪定、硫痠鎂在閤併心血管疾病患者ERCP手術中,舒芬太尼0．12μg/kg能維持較滿意的痳醉深度,術中血流動力學平穩,不良反應髮生率少,有良好的安全性。
목적：연구불동제량적서분태니재합병심혈관질병환자ERCP술중마취효과급안전성。방법111례ASAⅡ~Ⅲ급합병심혈관질병행ERCP술환자,수궤분위3조(n=37례)：S1조、S2조、S3조。매조경정맥10min수주우미탁미정0.5μg/kg후분별복합류산미10mg/kg+서분태니0．1μg/kg、0．12μg/kg、0．15μg/kg정맥완만주사。수즉혈장파공수주의탁미지,설정혈장농도0.5 ug/mL。매조술중채용지속빙주류산미6mg/( kg·h)+의탁미지파공혈장농도0.3~0.5μg/mL유지마취。근거BIS 치조정의탁미지적혈장농도,유지BIS치우55좌우。관찰병기록입실마취전、유도후、삽경시、내경치입십이지장유두、소성등불동시점평균동맥압( MAP)심솔( HR)、심솔수축압승적( RPP)、혈양포화도( SpO 2)、급각시점적BIS치。통계수술조작시간、마취소성급정향력회복시간화불량반응적발생솔。결과소유환자균교순리완성수술조작。 MAP급HR재삽경시、경입십이지장경유두개구시S2、S3명현저우S1조,차이유통계학의의( P<0．05)。수술전정S3조심동과완발생솔고우S2조,차이유통계학의의(P<0．05)。 RPP：경입십이지장경유두개구시S2、S3명현저우S1조,차이유통계학의의(P<0．01)。 BIS：유도후지경입십이지장S3각시점균명현저우S1,차이유통계학의의(P<0．01)；삽관시S3<S2<S1,차이유통계학의의(P<0．05),치입십이지장경시S3、S2<S1,차이유통계학의의(P<0．05)；SPO2：삽경시S3<S1,차이유통계학의의(P<0．05),경입십이지장유두시 S3<S2、S1,차이유통계학의의(P<0．05)。술중조동、창해발생솔S1조명현고우S2、S3조,차이유통계학의의(P<0．05),호흡억제발생솔S1、S2현저저우S3조(P<0．05),삼조환자무술중지효적발생。결론서분태니복합우미탁미정、류산미재합병심혈관질병환자ERCP수술중,서분태니0．12μg/kg능유지교만의적마취심도,술중혈류동역학평은,불량반응발생솔소,유량호적안전성。
Objective To study the comparison of intraoperative anesthetic effect and safety of different doses of sufen-tanil in patients with cardiovascular ERCP. Method 90 cases of ASA grade Ⅱ~Ⅲ patients with cardiovascular ERCP, who were randomly divided into 3 groups(n=37 cases):group S1,group S2,group S3. Each group was infused dexmedetomidine 10min by intravenous after 0. 5ug/kg, respectively composited magnesium sulfate 10mg/kg and sufentanil 0. 1ug/kg, 0. 12ug/kg, 0. 15ug/kg with intravenous injection slowly. Then the target plasma concentration of etomidate set the plasma concentration as 0. 5ug/ml. Each group was treated by magnesium sulfate continuous infusion of 6mg/(kg·h) + of the target plasma concentration of etomidate of 0. 3 ~0. 5ug/ml to maintain anesthesia. According to BIS,the plasma concentration of etomidate was adjusted to maintain the BIS at about 55 or so. Observed and recorded MAP、HR、RPP、SpO 2 and BIS at different time such as before anesthe-sia, after induction, when a mirror was inserted, endoscopic placement of duodenal papilla, recovery etc. . Add up the time of the surgery, anesthesia recovery,orientation recovery and the incidence rate of untoward reaction. Results All patients were success-fully completed the surgery. MAP and HR of group S2 and group S3 were significantly lower than those of group S1 ( P<0. 05 ) when the mirror was inserted and the mirror was in duodenal papilla. The heartbeat bradycardia of group S3 was significantly high-er than that in S2 group(P<0. 05)during the whole surgery. RPP:The RPP of group S2 and S3 were significantly lower than those of group S1(P<0. 01)when the mirror was in the duodenal papilla. BIS:After anesthesia induction to the mirror inserted the duo-denum,the BIS of group S3 was significantly lower than that of S1 at each time point(P<0. 01); when intubated:S3<S2<S1 (P<0. 05), when placed duodenoscope:S3、S2< S1(P<0. 05);SPO2:when intubated:S3<S1(P<0. 05),when the mirror in-serted the duodenal papilla:S3<S2、S1(P<0. 05). The intraoperative restlessness and the incidence of choking cough of group S1 were significantly higher than those of group S2 and group S3(P<0. 05), the incidence of respiratory depression of group S1 and group S2 was significantly lower than that of group S3(P<0. 05), three groups of patients knew nothing happened during the sur-gery. Conclusion Sufentanil composited dexmedetomidine and magnesium sulfate were during the ERCP in patients with cardio-vascular disease surgery, sufentanil of 0. 12ug/ kg could maintain satisfactory depth of anesthesia. Intraoperative hemodynamic is stable, less incidence of adverse reactions, there is good security.