丙泊酚复合瑞芬太尼在超声胃镜引导下胰腺穿刺活检术中的应用

摘要

目的：探讨丙泊酚复合瑞芬太尼静脉全身麻醉用于超声胃镜下胰腺穿刺活检术的安全性和可行性。方法选择美国麻醉师协会（ASA）Ⅰ～Ⅲ级，拟行超声胃镜引导下胰腺穿刺活检术的患者60例，随机分为两组，Ⅰ组：丙泊酚复合瑞芬太尼静脉全身麻醉组（n ＝30）；Ⅱ组：咪唑安定复合芬太尼神经安定镇痛组（n ＝30）。前者在丙泊酚联合瑞芬太尼静脉全身麻醉下完成胰腺穿刺术；后者于咪唑安定、芬太尼神经安定镇痛下完成手术。分别记录麻醉前（T0）、麻醉后进镜前（T1）、进镜至咽部（T2）、至胃窦部（T3）及超声胃镜取出后即刻（T4）的5个时点心率（HR）、血压（MBP）和脉搏血氧饱和度（SpO2）；观察手术期间不良反应；记录两组患者的手术时间、苏醒时间；调查内镜医师满意度及患者满意度。结果Ⅰ组患者术中血流动力学稳定；Ⅱ组 HR、MAP 值在术中各时点均升高，与 T0比较差异有统计学意义（P ＜0．05），组间术中相应时点比较亦差异有统计学意义（P ＜0．05）；Ⅰ组患者手术中出现恶心、呕吐、体动等不良反应明显少于Ⅱ组（P ＜0．05）。Ⅰ组患者的手术时间短于Ⅱ组[（23．87±5．56）min 比（36．52±7．31）min，P ＜0．05]。Ⅰ组患者均能在术毕即刻至5 min 内苏醒，麻醉满意度[（92．1±7．6）分比（64．3±6．4）分]及患者满意度[（93．3±6．6）分比（49．2±7．1）分]均高于Ⅱ组（P ＜0．05）。结论丙泊酚复合瑞芬太尼静脉全身麻醉用于无痛超声胃镜胰腺穿刺活检术效果良好且不良反应少，安全可靠，是一种理想的麻醉方法。%Objective To explore the feasibility and safety of intravenous anesthesia with remifentanil and propofol in Eus-guided pancreas biopsy.Methods 60 patients (ASA classⅠ-Ⅲ)sceheduled for Eus-guided pancre-as biopsy were allocated randomly to either Propofol anesthesia combined with remifentani group(groupⅠ,n =30)or neuroleptanalgesia group (groupⅡ,n =30).Heart rate(HR),mean blood pressure(MBP)and pulse oxygen satura-tion (SpO2 )were recorded at different time points:before the anesthesia (T0)and after the anaesthesia induction (T1),the time EUS at the level of pharynx(T2),gastric antrum (T3),and out of the EUS(T4).Side effects during the operation were also observed.The operating time and recovery time of the two groups were recorded,intraoperative satisfication(evaluated by Endoscopy Doctor)and patient satisfication(evaluated by patient)were also analyzed.Re-sults The hemodynamics were more stable in groupⅠ than those in group Ⅱ,Less nausea and vomiting and body movement happened in Group Ⅰ than those in Group Ⅱ (P <0.05).The operating time in Group Ⅰ was significant-ly shorter than that in Group Ⅱ(P <0.05).All patients in group Ⅰ waked up in 0-5 minute of post-operative.Intra-operative satisfication and patient satisfication were both higher in group Ⅰ than those in group Ⅱ.Conclusion Propofol anesthesia combined with remifentani is safe and effective for Eus-guided pancreas biopsy in the patients with pancreatic mass.