文章摘要
小剂量艾司氯胺酮复合环泊酚用于老年患者内镜下逆行胰胆管造影术的效果
Efficacy of low-dose esketamine combined with cyclopofol in elderly patients undergoing endoscopic retrograde cholangiopancreatography
  
DOI：10.12089/jca.2023.03.008
中文关键词: 艾司氯胺酮  环泊酚  舒芬太尼  老年  逆行胰胆管造影术
英文关键词: Esketamine  Cyclopofol  Sufentanil  Aged  Retrograde cholangiopancreatography
基金项目:辽宁省民生科技计划项目（2021JH2/10300011）
作者单位E-mail
崔波 110016,沈阳市,北部战区总医院麻醉科  
汪海涛 110016,沈阳市,北部战区总医院麻醉科  
王超 110016,沈阳市,北部战区总医院麻醉科  
赵婉彤 110016,沈阳市,北部战区总医院麻醉科  
刁玉刚 110016,沈阳市,北部战区总医院麻醉科  
宋丹丹 110016,沈阳市,北部战区总医院麻醉科 songdandan6@163.com 
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中文摘要:
      
目的 探讨小剂量艾司氯胺酮复合环泊酚用于老年患者行内镜下逆行胰胆管造影术（ERCP）的安全性和有效性。
方法 选择2021年10月至2022年3月择期行ERCP的老年患者80例，男42例，女38例，年龄70～100岁，BMI 18～30 kg/m 2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：艾司氯胺酮复合环泊酚组（EC组）和舒芬太尼复合环泊酚组（SC组），每组40例。EC组给予艾司氯胺酮0.3 mg/kg+环泊酚0.3 mg/kg进行麻醉诱导，SC组给予舒芬太尼0.1 μg/kg+环泊酚0.3 mg/kg进行麻醉诱导。记录入室左侧卧位即刻（T0）、诱导成功即刻（T1）、取石即刻（T2）、固定鼻胆管即刻（T3）的HR、MAP和SpO2O。记录手术时间、麻醉起效时间（从诱导开始至患者意识或睫毛反射消失的时间）、诱导期环泊酚用量、术中环泊酚用量、术中血管活性药物使用情况。记录苏醒时间，术中呛咳、体动、呼吸抑制、低血压，术后恶心呕吐等不良反应发生情况以及术后15 min静息时VAS疼痛评分。
结果 与SC组比较，EC组T1—T3时HR明显增快，MAP明显升高；T1时SpO2O明显升高；麻醉起效时间、苏醒时间明显缩短，诱导期环泊酚用量、术中环泊酚用量明显减少，术中血管活性药物使用率、呼吸抑制和低血压发生率明显降低（P<0.05）。两组手术时间，术中呛咳、体动，术后恶心呕吐发生率及术后15 min静息时VAS疼痛评分差异无统计学意义。
结论 小剂量艾司氯胺酮用于老年患者ERCP安全有效，可提供有效镇痛，术中循环稳定，呼吸抑制发生率低。
英文摘要:
      
Ojective To investigate the safety and efficacy of low-dose esketamine combined with cyclopofol in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).
Methods Eighty elderly patients from Octomber 2021 to March 2022, 42 males and 38 females, aged 70-100 years, BMI 18-30 kg/m 2, ASA physical status Ⅱ or Ⅲ, underwent ERCP were enrolled. Patients were divided into two groups by random number table method: esketamine combined with cyclopofol group (group EC) and sufentanil combined with cyclopofol group (group SC), 40 patients in each group. Group EC was given esketamine 0.3 mg/kg and cyclopofol 0.3 mg/kg for anesthesia onset, group SC was given sufentanil 0.1 μg/kg and cyclopofol 0.3 mg/kg for anesthesia onset. HR, MAP and SpO2O immediately after entering operation room with left lying position (T0), successful induction (T1), stone removal (T2), and after nasobiliary duct fixation immediately (T3) were recorded. The operation time, anesthesia onset time, the doasge of cyclopofol after successful induction and intraoperation, intraoperative application of vasoactive drugs, awakening time, adverse reactions (choking, body movement, respiratory depression, hypotension, postoperative nausea and vomiting), and VAS pain scores at rest 15 minutes after operation were recorded.
Results Compared with group SC, HR and MAP were significantly increased at T1-T3, SpO2O was significantly increased at T1, the anesthesia onset time and awakening time were significantly shorterned, the doasge of cyclopofol after successful induction and intraoperation were significantly decreased, the ratio of application vasoactive drugs, hypotension, and respiratory depression were significantly decreased in group EC (P < 0.05). There were no significant differences in choking, body movement, postoperative nausea and vomiting, and VAS pain scores at rest 15 minutes after operation between the two groups.
Conclusion Low-dose esketamine is safe and effective for ERCP in elderly patients, which can provide effective analgesia, more stable intraoperative circulation and lower incidence of respiratory depression.
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