布托啡诺复合右美托咪啶用于老年人 内镜逆行胰胆管造影术

The application of butorphanol associated with dexmedetomidine for endoscopic retrograde cholangiopancreatography in the elderly

摘要:

目的 观察布托啡诺复合右美托咪啶用于老年人ERCP的效果。方法 拟行ERCP老年患者40例，随机分为观察组和对照组，每组20例。两组于手术开始前15 min内均静脉泵注射右美托咪啶0.5μg/kg，继以0.5μg/（kg·h）维持至手术结束，观察组手术前5 min复合静脉注射布托啡诺1 mg。记录麻醉开始前（T0）、静脉注射右美托咪啶和布托啡诺后（T1）、进镜（T2）、十二指肠乳头插管（T3）、注入照影剂（T4）及术毕（T5）时的平均动脉压（MAP）、HR、RR和SPO2及T1～T5时点Ramsay评分，观察心动过缓、低血压、低氧血症、心律失常和镇静过度等不良反应的发生率及患者的配合度及满意度。结果 对照组T3时点MAP与观察组比较差异有显著性（P <0.05）；对照组术中各时点Ramsay评分与观察组比较差异有显著性（P <0.05）；观察组患者配合度和满意度优于观察组（P <0.05）。结论 布托啡诺复合右美托咪啶用于老年人ERCP，血流动力学平稳，镇痛镇静效果好，术中患者配合度和满意度高，且不增加不良反应。

Abstract:

【Objective】 To determine the effect of butorphanol associated with dexmedetomidine for endoscopic retrograde cholangiopancreatography in the elderly. 【Methods】 Forty elderly patients scheduled to undergo endoscopic retrograde cholangiopancreatography were randomly assigned to two groups (observation and control group) with 20 each. All patients received intravenous 0.5μg/(kg·h) dexmedetomidine after 0.5μg/kg bolus within 15 minutes. Intravenous butorphanol 1 mg was added in observation group. MAP, HR, RR and SPO2 were observed before anesthesia (T0), after intravenous dexmedetomidine and butorphanol (T1), at putting endoscope into stomach (T2), duodenal intubation (T3), contrast medium infusion (T4), the end of surgery (T5). Rasmay sedation score was determined at T1~T5. Patient compliance and satisfaction, the adverse effect such as bradycardia, hypotension, hypoxia, arrhythmia, excessive sedation were also recorded. 【Results】 MAP at T3 in control group was higher (P <0.05). Rasmay sedation scores were obviously lower at T1~T5 in observation group (P <0.05). The observation group was superior to control group in patient compliance and satisfaction (P <0.05). 【Conclusion】 Butorphanol associated with dexmedetomidine for endoscopic retrograde cholangiopancreatography in the elderly can get stable haemodynamics, satisfactory analgesia and sedation and excellent patient compliance and satisfaction.