关键词: 肝硬化, 食管静脉曲张破裂出血, 硬化剂注射治疗, 麻醉, 丙泊酚, 地佐辛, 治疗

Abstract: Objective The aim of this study was to investigate dezocine anesthesia induction and propofol target-controlled infusion maintaining in patients withliver cirrhosis (LC) and esophageal variceal bleeding (EVB) underwent endoscopic sclerotherapy. Methods 64 hepatitis B-induced LC patients with EVB encountered in our hospital underwent endoscopic lauromacrogol injection, and 32 patients were assigned to control and another 32 to observation group. For anesthesia, the propofol target-controlled infusion was maintained in the two groups, and dezocine induction was given in the observation, additionally. The postoperative pain was evaluated by visual analogue scale (VAS). Serum neuropeptide Y (NPY), substance P (SP), norepinephrine (NE) and dopamine (DA) levels were detected by ELISA, and serum total antioxidant capacity (T-AOC), superoxide dismutase (SOD) and malondialdehyde (MDA) levels were routinely assayed. Results The mean arterial pressure and heart rate at anesthesia induction and endoscopic insertion in the observation were significantly greater or quicker than in the control(P＜0.05); the propofol dosage in the observation was (461.3±14.1)mg, much lower than [(482.9±15.8)mg, P＜0.05], wake-up time was (5.1±1.3)min, much shorter than [(6.7±1.4)min, P＜0.05] in the control, while there was no significant difference in restless scores between the two groups (P>0.05); at 1 hour and 3 hours after operation, the static and dynamic VAS scores in the observation were much lower than in the control (P＜0.05); at the end of six hours after endoscopic sclerotherapy, serum NPY, SP, DA and NE levels in the observation were (155.7±21.9)pg/mL,(2.6±0.6)g/mL, (71.6±11.2)mmol/L and (2.5±0.6)pg/mL, all significantly lower than [(189.3±22.8)pg/mL, (3.8±0.8)g/mL, (84.3±12.7)mmol/L and (3.9±0.5)pg/mL, respectively, P＜0.05] in the control; serum SOD and T-AOC levels were (73.1±6.1)U/mL and (15.2±1.4)U/mL, both significantly higher than [(64.2±5.7)U/mL and (12.0±1.1)U/mL, P＜0.05], while serum MDA level was (3.7±0.6)mmol/L, significantly lower than [(6.2±0.7)mmol/L, P＜0.05] in the control; the incidence of nausea and vomiting in the observation was 3.1%, much lower than 25.0%(P＜0.05) in the control group. Conclusion During endoscopic sclerotherapy, the dezocine induction before propofol maintaining analgesia could improve the analgesic effects and decrease adverse events in patients with EVB, which might be related to the inhibition of oxidative stress.

Key words: Liver cirrhosis, Esophageal variceal bleeding, Endoscopic sclerotherapy, Anesthesia, Propofol, Dezocine, Therapy