右美托咪定复合丙泊酚靶控输注处理ERCP治疗胆总管结石患者麻醉效果研究*

doi:10.3969/j.issn.1672-5069.2026.05.033

摘要/Abstract

摘要： 目的分析总结应用右美托咪定复合丙泊酚靶控输注(TCI)处理经内镜逆行胰胆管造影术(ERCP)治疗胆总管结石患者的麻醉效果。方法 2023年1月～2025年5月我院收治的102例胆总管结石患者,均行择期ERCP术治疗。随机将患者分为对照组51例和观察组51例,分别采用舒芬太尼复合丙泊酚TCI麻醉或右美托咪定复合丙泊酚TCI麻醉,记录麻醉时间、苏醒时间、麻醉恢复时间,采用监护仪监测入室(T₀)、诱导完成(T₁)、置入内镜(T₂)、置入内镜10 min(T₃)、停止给药(T₄)和恢复室入室5 min(T₅)时心率(HR)、平均动脉压(MAP)和氧饱和度(SpO₂),并评估Ramsay镇静量表(RSS)评分,应用视觉模拟评分(VAS)评估疼痛,采用ELISA法检测血浆皮质醇(Cor)、促肾上腺皮质激素(ACTH)和肿瘤坏死因子α(TNF-α)水平。结果在T₂～T₅时,观察组HR和MAP均显著低于对照组(P<0.05),在T₁～T₄时,观察组RSS评分显著高于对照组(P<0.05);在术后,观察组血浆Cor、ACTH和TNF-α水平分别为(228.6±34.6)mmol/L、(18.5±3.6)、pmol/L和(30.1±3.5)pg/mL,均显著低于对照组【分别为(269.0±33.9)mmol/L、(25.4±4.3)pmol/L和(41.8±5.9)pg/mL,P<0.05】。结论应用右美托咪定复合丙泊酚TCI处理ERCP术治疗的胆总管结石患者可获得良好的麻醉效果,可能与其减轻了术后应激反应有关。

关键词: 胆总管结石, 经内镜逆行胰胆管造影术, 右美托咪定, 丙泊酚, 靶控输注, 麻醉

Abstract: Objective The aim of this study was to investigate sedation of dexmedetomidine and propofol combination for target-controlled infusion (TCI) in patients with common bile duct stones (CBDS) undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods 102 patients with CBDS were encountered in our hospital between January 2023 and May 2025, and they all underwent selective ERCP. For sedation, they were randomly divided into control (n=51) and observation group (n=51), receiving sufentanil and propofol combination for TCI or dexmedetomidine and propofol combination for TCI, respectively. Anesthesia time, recovery time and anesthesia recovery time were recorded. Heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO₂) were monitored by a monitor at time of entering operating room (T₀), induction completion (T₁), endoscope insertion (T₂), 10 min after endoscope insertion (T₃), discontinuation of drug administration (T₄) and at 5 min after entering the recovery room (T₅). Ramsay sedation scale (RSS) score was evaluated, and visual analogue scale (VAS) was used to evaluate pain. Plasma cortisol (Cor), adrenocorticotropic hormone (ACTH) and tumor necrosis factor-α (TNF-α) levels were detected by ELISA. Results At T₂ to T₅, HR and MAP in the observation group were significantly lower than in the control group (P<0.05), and at T₁ to T₄, the RSS scores in the observation group were significantly higher than in the control group (P<0.05); after surgery, serum Cor, ACTH and TNF-α levels in the observation group were (228.6±34.6) mmol/L, (18.5±3.6) pmol/L and (30.1±3.5) pg/mL, all significantly lower than [(269.0±33.9) mmol/L, (25.4±4.3) pmol/L and (41.8±5.9) pg/mL, respectively, P<0.05) in the control group. Conclusion TCI by dexmedetomidine in combination with propofol has a satisfactory sedation in patients with CBDS undergoing ERCP, which might relieve postoperative body stress.

Key words: Common bile duct stones, Endoscopic retrograde cholangiopancreatography, Dexmedetomidine, Propofol, Target-controlled infusion, Sedation

陶巧建, 仲华根, 潘洪喜. 右美托咪定复合丙泊酚靶控输注处理ERCP治疗胆总管结石患者麻醉效果研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 769-772.

Tao Qiaojian, Zhong Huagen, Pan Hongxi. Sedation of dexmedetomidine and propofol combination for target-controlled infusion in patients with common bile duct stones undergoing ERCP[J]. Journal of Practical Hepatology, 2026, 29(5): 769-772.

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右美托咪定复合丙泊酚靶控输注处理ERCP治疗胆总管结石患者麻醉效果研究^*

Sedation of dexmedetomidine and propofol combination for target-controlled infusion in patients with common bile duct stones undergoing ERCP

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