非气管插管下行无痛内镜逆行胰胆管造影术的临床分析

Clinical analysis of painless endoscopic retrograde cholangiopancreatography without endotracheal intubation

摘要:

目的 评价非气管插管下行无痛内镜下逆行胰胆管造影术（ERCP）的有效性及安全性。方法 纳入2019年7月1日－2020年6月30日该院行无痛ERCP的患者143例（无痛ERCP组）和2018年7月1日－2019年6月30日行普通ERCP的患者141例（普通ERCP组），比较两组患者术前疾病构成情况、术中情况、插管成功率、结石二次清理率和术后并发症发生情况。结果 无痛ERCP组中，19例（13.29%）术中出现一过性低氧血症，经加大给氧流量、抬起下颌、减慢给药速度、调整用药方案和球囊加压给氧后均迅速缓解，未出现转气管插管和麻醉相关不良事件；普通ERCP组中，有12例患者因配合度差提前结束手术。无痛ERCP组患者耐受率明显优于普通ERCP组，两组比较，差异有统计学意义（P < 0.01）。无痛ERCP组结石二次清理率为0.93%（1/107），低于普通ERCP组的7.69%（9/117），两组比较，差异有统计学意义（􀱽² = 6.75，P < 0.01）。无痛ERCP组术后高淀粉酶血症发生率16.78%（24/143）低于普通ERCP组的28.37%（40/141），两组比较，差异有统计学意义（􀱽² = 5.46，P < 0.05）。结论 无痛ERCP安全有效，明显提高了患者的手术耐受性，降低了结石二次清理率和术后高淀粉酶血症发生率。

Abstract:

Objective To evaluate the efficacy and safety of painless endoscopic retrograde cholangiopancreatography (ERCP) without endotracheal intubation.Methods 143 patients who underwent painless ERCP from July 1st 2019 to June 30th 2020 (painless ERCP group) and 141 patients who underwent ordinary ERCP from July 1st 2018 to June 30th 2019 (ordinary ERCP group) were enrolled. The preoperative disease composition, intraoperative conditions, intubation success rate, secondary clearance rate of stone and complications after surgery were compared between the two groups.Results There was 19 cases (13.29%) developed transient hypoxemia during the operation in the painless ERCP group, the patients were relieved rapidly after increasing the oxygen flow, raising the jaw, slowing down the rate of administration, adjusting the medication regimen and pressurizing the oxygen with a balloon. No conversion to endotracheal intubation and sedation-related adverse events occurred. There were 12 cases ended the operation ahead of schedule due to poor cooperation in the ordinary ERCP group. The tolerance rate of patients in the painless ERCP group was significantly better than that in the ordinary ERCP group, and the difference between the two groups was statistically significant (P < 0.01). The secondary stone clearance rate of ERCP in the painless group (0.93%, 1/107) was lower than that in the control group (7.69%, 9/117), and the difference was statistically significant (χ² = 6.75, P < 0.01). The incidence rate of post-ERCP hyperamylasemia in the painless group was 16.78% (24/143), which was lower than that in the control group (28.37%, 40/141), and the difference was statistically significant (χ² = 5.46, P < 0.05).Conclusion Painless ERCP is safe and efficient, which could significantly improve the patient's surgical tolerance, and reduce the incidence rate of secondary stone clearance and post-ERCP hyperamylasemia.