盐酸羟考酮复合丙泊酚靶控输注处理接受内镜治疗的胆总管结石患者麻醉效果研究*

doi:10.3969/j.issn.1672-5069.2024.05.037

摘要/Abstract

摘要： 目的探讨应用盐酸羟考酮复合丙泊酚靶控输注对接受内镜治疗的胆总管结石患者的麻醉效果。方法 2021年6月～2023年6月我院诊治的胆总管结石患者75例,被随机分为对照组37例和观察组38例。两组均接受内镜下逆行胰胆管造影(ERCP)胆总管取石术治疗。在对照组,采用靶控输注丙泊酚联合瑞芬太尼麻醉,给予观察组静脉输注盐酸羟考酮联合靶控输注丙泊麻醉。在诱导前(T0)、诱导后5 min(T1)、进镜至十二指肠乳头时(T2)和术毕(T3)平均动脉血压(MAP)、心率(HR)和麻醉深度(BIS);采用放射免疫法检测血浆皮质醇(Cor),采用ELISA法检测血浆去甲肾上腺素(NE),采用己糖激酶法检测血糖(Glu)水平。分别应用Ramsay评分和视觉模拟评分(VAS)评估镇静和镇痛效果。结果在T2时,观察组MAP比对照组降低了2.8%(95%CI:-5.0%～0.1%,P<0.05),HR比对照组降低了4.3%(95%CI:-6.6%～-0.1%,P<0.05),BIS比对照组降低了2.1%(95%CI:-2.4%～-0.2%,P<0.05);观察组血清Cor水平比对照组降低了-11.7%(95%CI:-13.6%～1.1%,P<0.05),NE比对照组降低了10.3%(95%CI:-15.4%～0.04%,P<0.05),Glu比对照组降低了11.9%(95%CI:-16.2%～1.7%,P<0.05);在苏醒后30 min(N1)和苏醒2 h(N2)时,观察组VAS评分分别降低了14.3%(95%CI:-16.0%～1.6%,P<0.05)和16.0%(95%CI:-18.1%～1.9%,P<0.05); 观察组丙泊酚用量比对照组减少了9.6%(95%CI:-14.7%～3.1%,P<0.05)。结论应用盐酸羟考酮复合丙泊酚靶控输注麻醉接受内镜治疗的胆总管结石患者术中血流动力学影响相对较小,可维持稳定的麻醉深度,减轻应激反应和术后疼痛,丙泊酚用量减少。

关键词: 胆总管结石, 内镜下逆行胰胆管造影术, 盐酸羟考酮, 丙泊酚, 麻醉

Abstract: Objective The aim of this study was to investigate anesthesia of oxycodone hydrochloride and propofol combination by target-controlled infusion in patients with choledocholithiasis undergoing endoscopic retrograde cholangiopancreatography (ERCP) treatment. Methods In this clinical trial, we enrolled 75 patients with imaging-confirmed choledocholithiasis between June 2021 and June 2023, and all underwent ERCP for removal of common bile duct stones. We randomly assigned patients to receive target-controlled infusion of propofol and remifentanil (control, n=37) or intravenous infusion of oxycodone hydrochloride before target-controlled infusion of propofol for anesthesia induction and maintenance. The mean arterial pressure (MAP), heart rate (HR) and anesthesia depth (BIS) were routinely monitored before induction (T0), 5 min after induction (T1), at the time of endoscopy to duodenal papilla (T2) and at the end of surgery (T3). Serum cortisol (Cor) levels was detected by radioimmunoassay, serum norepinephrine (NE) level was measured by ELISA, and serum glucose (Glu) level was detected by hexokinase method. Ramsay score was used to evaluate the sedation status, and visual analogue scale (VAS) was adopted to evaluate the analgesia effect. Results By T2, MAP in the observation decreased by 2.8%(95%CI:-5.0%-0.1%, P<0.05),HR decreased by 4.3%(95%CI:-6.6%-0.1%, P<0.05), and BIS decreased by 2.1%(95%CI:-2.4%-0.2%, P<0.05) as compared to in the control; serum Cor level decreased by -11.7%(95%CI:-13.6%-1.1%, P<0.05), serum NE level decreased by 10.3%(95%CI:-15.4%-0.04%, P<0.05), and blood Glu level decreased by 11.9%(95%CI:-16.2%-1.7%, P<0.05) compared to those in the control; by 30 minutes after waking-up (N1) and 2 hours after waking-up (N2), the VAS scores in the observation decreased by 14.3%(95%CI:-16.0%-1.6%, P<0.05) and 16.0%(95%CI:-18.1%-1.9%,P<0.05) as compared to those in the control; the dosage of propofol used in the observation decreased by 9.6%(95%CI:-14.7%-3.1%, P<0.05) compared to that in the control. Conclusion The intravenous administration of oxycodone hydrochloride and target-controlled infusion of propofol for anesthesia in patients with choledocholithiasis undergoing ERCP has clinically meaningful anesthesia, with relatively small effect on intraoperative hemodynamics and less body stress reaction.

Key words: Choledocholithiasis, Endoscopic retrograde cholangiopancreatography, Oxycodone hydrochloride, Propofol, Anesthesia

李鹏程, 李利, 陈瑞清, 王艳红, 魏琦, 王楠. 盐酸羟考酮复合丙泊酚靶控输注处理接受内镜治疗的胆总管结石患者麻醉效果研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 793-796.

Li Pengcheng, Li Li, Chen Ruiqing, et al. Anesthesia of oxycodone hydrochloride and propofol combination by target-controlled infusion in patients with choledocholithiasis undergoing ERCP treatment[J]. Journal of Practical Hepatology, 2024, 27(5): 793-796.

参考文献

[1] Mínguez A, Ladrón P, Martínez S,et al. Predictive model of persistent choledocholithiasis in patients with acute biliary pancreatitis. Gastroenterol Hepatol, 2023,46(4):297-304.
[2] Cianci P, Restini E. Management of cholelithiasis with choledocholithiasis: endoscopic and surgical approaches. World J Gastroenterol, 2021,27(28):4536-4554.
[3] Zhang CC, Ganion N, Knebel P,et al. Sedation-related complications during anesthesiologist-administered sedation for endoscopic retrograde cholangiopancreatography: a prospective study. BMC Anesthesiol, 2020,20(1):131.
[4] De Vico P, Biasucci DG, Aversano L,et al. Feasibility and safety of deep sedation with propofol and remifentanil in spontaneous breathing during endoscopic retrograde cholangiopancreatography: an observational prospective study. BMC Anesthesiol, 2023,23(1):260.
[5] Ahlström SE, Bergman PH, Jokela RM,et al. Clinical and genetic factors associated with post-operative nausea and vomiting after propofol anaesthesia. Acta Anaesthesiol Scand, 2023,67(8):1018-1027.
[6] Kowalski G, Olczak B, Leppert W,et al. Analgesic efficacy and safety of spinal oxycodone in total hip arthroplasty: a preliminary study. Curr Med Chem, 2022,29(21):3806-3814.
[7] Yao J, Hao S, Zhou C,et al. Application of low-dose etomidate combined with oxycodone and midazolam in endoscopic injection sclerotherapy. Int J Clin Pharmacol Ther, 2023,61(3):122-128.
[8] 中国研究型医院学会肝胆胰外科专业委员会,国家卫生健康委员会公益性行业科研专项专家委员会. 肝胆管结石病微创手术治疗指南(2019年版). 中华消化外科杂志,2019,18(5):407-413.
[9] 樊顺克,王贵罗,伊晓燕. 七氟醚联合丙泊酚静-吸复合麻醉用于原发性肝癌根治术治疗经验介绍. 实用肝脏病杂志,2022,25(5):702-705.
[10] Li Y, An M, Ding Y,et al. Oxycodone-acetaminophen versus celecoxib for postoperative pain in knee osteoarthritis patients after total knee arthroplasty: a randomized, controlled study. Arch Orthop Trauma Surg, 2023,143(11):6753-6762.
[11] 史济华,秦肖芸,刚锐,等. 丙泊酚联合芬太尼静脉麻醉对高龄患者经内镜逆行胰胆管造影术治疗的安全性. 中华老年医学杂志,2019,38(6):658-661.
[12] Hormati A, Aminnejad R, Saeidi M,et al. Prevalence of anesthetic and gastrointestinal complications of endoscopic retrograde cholangiopancreatography. Anesth Pain Med, 2019,9(4):e95796.
[13] Joy PJ, Blanshard HJ. Propofol-remifentanil patient-controlled sedation for endoscopic procedures: a prospective service audit. Can J Anaesth, 2023,70(11):1735-1743.
[14] Xin Z, Wang N, Wang H. Remimazolam and remifentanil use induced severe respiratory depression and laryngeal spasm during intravenous sedation and analgesia:a case report. Curr Drug Saf, 2023,1(1):17.
[15] Iorno V, Landi L, Porro GA,et al. Long-term effect of oxycodone/naloxone on the management of postoperative pain after hysterectomy: a randomized prospective study. Minerva Anestesiol, 2020,86(5):488-497.
[16] Guo P, Wu H, Liu L,et al. Efficacy of an oxycodone-propofol combination versus a fentanyl-propofol combination in conscious sedation during therapeutic endoscopic retrograde cholangiopancreatography in elderly patients. Gerontology, 2021,67(1):9-16.
[17] Niu L, Chen L, Luo Y,et al. Oxycodone versus morphine for analgesia after laparoscopic endometriosis resection. BMC Anesthesiol, 2021,21(1):194.
[18] Wu WT, Jia ZY, Chen Y,et al. The safety and efficacy of oxycodone versus fentanyl in percutaneous microwave ablation of a liver tumour abutting the capsule. Cardiovasc Intervent Radiol, 2019,42(1):87-94.
[19] Yao J,Song C, Zhou C, et al. Different doses of oxycodone for endoscopic injection sclerotherapy of esophageal varices. Med Sci Monit, 2021,27(1):e929111.
[20] Wang GR, Wu Q, Liu WP,et al. Effect of oxycodone hydrochloride combined with dexmedetomidine on quality of recovery and stress response after general anesthesia in patients who had laparoscopic cholecystectomy. Pak J Med Sci, 2021,37(5):1408-1413.
[21] Zhang J, Tu Q, Gan J,et al. Preemptive anti-stress response effects of oxycodone versus sufentanil for patients undergoing cardiac valve replacement-a randomized controlled trial. Clin Pharmacol Drug Dev, 2020,9(3):321-329.
[22] Wu J, Lu Y, Cao X. Different effects of oxycodone and remifentanil in patients undergoing ultrasound-guided percutaneous radiofrequency ablationof hepatic cancer: a randomized trial. Drug Des Devel Ther, 2019,13(1):365-372.
[23] Annborn M, Ceric A, Borgquist O,et al. Hypothermia versus normothermia after out-of-hospital cardiac arrest; the effect on post-intervention serum concentrations of sedatives and analgesics and time to awakening. Resuscitation, 2023,188(1):109831.

盐酸羟考酮复合丙泊酚靶控输注处理接受内镜治疗的胆总管结石患者麻醉效果研究^*

Anesthesia of oxycodone hydrochloride and propofol combination by target-controlled infusion in patients with choledocholithiasis undergoing ERCP treatment

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	张召, 王玲玲, 吕婷, 刘欣, 徐玉. 胆总管结石患者胆汁中性粒细胞胞外诱捕网激活水平及其临床意义探讨^*[J]. 实用肝脏病杂志, 2024, 27(5): 781-784.
[2]	向红, 叶立, 黄建峰. 纳美芬处理腹腔镜胆囊切除术治疗胆囊结石患者苏醒和认知功能变化研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 785-788.
[3]	李维新, 索爱军, 王秀峰. 地佐辛联合丙泊酚靶控输注处理接受内镜下注射硬化剂治疗的乙型肝炎肝硬化并发食管静脉曲张破裂出血患者麻醉苏醒和镇痛效果研究^*[J]. 实用肝脏病杂志, 2024, 27(4): 575-578.
[4]	王红霞, 胥晓倩, 于明帅. 内镜下硬化剂治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者应用不同剂量羟考酮联合丙泊酚靶控输注麻醉效果研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 230-233.
[5]	王莹莹, 周平, 程蕾. 右美托咪定复合七氟醚麻醉接受肝叶切除术治疗原发性肝癌患者麻醉效果分析^*[J]. 实用肝脏病杂志, 2024, 27(2): 267-270.
[6]	何晓非, 陈杰, 罗国松, 陆世峰. ERCP治疗急性梗阻性化脓性胆管炎患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 291-294.
[7]	唐昊, 杨天福. 腹腔镜胆总管探查术联合经腹直肌引出T管与经右锁骨中线引出引流治疗胆总管结石患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 295-298.
[8]	胡光明, 周涛, 肖杰, 孙占虎, 高宇, 裴豆豆. 腹腔镜下胆囊切除术联合腹腔镜下胆总管探查术治疗胆囊结石合并胆总管结石患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(1): 129-132.
[9]	刘明, 王金婷, 杨士彦, 杨位轩, 万元春. ESPBD与EST治疗肝硬化合并胆总管结石患者疗效比较^*[J]. 实用肝脏病杂志, 2023, 26(6): 915-918.
[10]	古乾权, 陈杰, 邓开. 双镜联合治疗胆囊结石合并肝外胆管结石患者疗效及安全性分析^*[J]. 实用肝脏病杂志, 2023, 26(6): 919-922.
[11]	余波, 余雯雯, 徐敏. 不同浓度七氟醚吸入复合丙泊酚靶控输注麻醉对行肝叶切除治疗的原发性肝癌患者血流动力学和术后认知功能的影响^*[J]. 实用肝脏病杂志, 2023, 26(5): 714-717.
[12]	叶超荣, 张涛, 吴永军, 利民. LCBDE与ERCP术治疗胆总管结石患者效果研究^*[J]. 实用肝脏病杂志, 2023, 26(5): 742-745.
[13]	刘泽军, 慕海峰, 陈升宝, 王春, 徐刚. LC联合LCBDE同步手术治疗胆囊结石合并胆总管结石患者临床疗效研究^*[J]. 实用肝脏病杂志, 2023, 26(4): 576-579.
[14]	张福, 陈俊卯, 梁晓辉. LCBDE术一期缝合治疗胆总管结石患者效果研究^*[J]. 实用肝脏病杂志, 2023, 26(1): 128-131.
[15]	刘颂航, 高友逵, 曹良启. LC联合ERCP治疗胆囊结石合并肝外胆管结石患者疗效研究^*[J]. 实用肝脏病杂志, 2023, 26(1): 132-135.