目的 评价瑞芬太尼靶控输注(TCI)技术在老年患者行治疗性内镜逆行胰胆管造影(ERCP)中的疗效及安全性. 方法 390例(年龄≥65岁)接受治疗性ERCP老年患者,分为两组,其中瑞芬太尼组175例采用瑞芬太尼清醒镇痛麻醉技术,利多卡因组215例采用传统利多卡因局部麻醉.持续监测并定时记录患者在治疗性ERCP过程中的血压、心率和血氧饱和度的变化,术后随访患者术中记忆和疼痛感觉及术后不良反应. 结果 两组患者术中心率和血压及血氧饱和度波动差异不明显.瑞芬太尼组165例(94.3％)麻醉效果满意,10例(5.7％)患者术中有轻度痛感,能忍受；7例(6.7％)术中出现循环及呼吸等不良反应,经对症治疗后好转.利多卡因组25例(8.6％)术中出现循环及呼吸等不良反应,2例因剧烈呃逆、呕吐而终止手术. 结论 瑞芬太尼靶控输注技术用于老年治疗性ERCP患者麻醉效果满意,不良反应少,值得临床推广应用.%Objective To assess the effectiveness and safety of target-controlled infusion (TCI) of remifentanil during remedial endoscopic retrograde cholangiopancreatography (ERCP) in the elderly patients. Methods 390 patients (aged 65 years and over) undergoing ERCP were divided into two groups: remifentanil group (n =175) and lidocaine group (n =215). Remifentanil group were anaesthetized by TCI with remifentanil as method of sensible analgesia,while lidocaine group were anaesthetized by lidocaine as conventional local anesthesia.Arterial blood pressure,heart rate and oxygen saturation (SpO2) were monitored during ERCP.The memory and feeling of pain during operation and side effects after operation were followed up. Results The statistical differences in changes of blood pressure,heart rate and SpO2 were not found between the two groups.There were 165 cases(94.3 ％) with satisfactory anaesthetization,10 cases (5.7 ％ ) with mild and endurable pain and 7 cases(6.7％) with side effects of circulation and respiration during operation,while these symptoms improved after symptomatic treatment in remifentanil group.In lidocaine group,there were 25 cases(8.6 ％ ) with side effects of circulation and respiration during operation,most of patients were obviously uncomfortable,2 cases (1.8％) were intolerant of operation. Conclusions Targetcontrolled infusion of remifentanil during ERCP in the elderly is safe,effective and worthy of clinical popularization.
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