瑞芬太尼复合右美托咪定清醒镇静技术在47例90岁以上患者ERCP中的应用体会

The efficacy of remifentanil and Dex-based conscious sedations during therapeutic ERCP in 47 patients over 90 years of age.

摘要:

背景和目的：逆行胰胆管造影操作时间长，手术刺激大，需要麻醉药物来消除不良刺激。随着社会老龄化趋势，需行ERCP的高龄患者也渐增多。临床上还未找到一种理想的麻醉方案可以快速平稳的诱导，安全有效的维持，同时无不良反应并能迅速苏醒。本文探讨瑞芬太尼复合右美托咪定清醒镇静技术在高龄患者ERCP中的应用价值 方法：47例90岁以上的老年患者接受瑞芬太尼、右美托咪定、丙泊酚、依托咪酯和氯胺酮诱导，维持用瑞芬太尼、右美托咪定和丙泊酚。遇有体动等镇静镇痛不足表现时酌情追加瑞芬太尼和/或丙泊酚。 结果：所有病人均顺利完成诊治。用药量小，循环呼吸平稳，不良反应少，检查结束患者即能立即苏醒，患者和医师满意度较高。 结论：瑞芬太尼复合右美托咪定清醒镇静技术高龄患者ERCP中能提供安全稳定的镇静镇痛水平，提高患者医师满意度。

Abstract:

Background and Aims:Endoscopic retrograde cholangiopancreatography ERCP is a painful and long procedure requiring transient deep analgesia and conscious sedation. As society ages,the elderly need for ERCP is increasing.An ideal anaesthetic that guarantees a rapid and smooth induction, good quality of maintenance, lack of adverse effects and rapid recovery is still lacking.This study evaluated the safety and efficacy of remifentanil and Dexmedetomidine-based sedations during therapeutic ERCP in 47 patients over 90 years of age. Methods: A total of 47 patients over 90 years of age who required therapeutic ERCP were enrolled. Induced with remefentanil, dexmedetomidine, propofol,etomidate and ketamine, then maintained with remefentanil, dexmedetomidine and propofol.Remifentanil or propofol was added if there was any symptoms of movements. Results: All the patients fufilled the therapy. The dose of drugs was low, but the circulation and respiration were smooth. Both paients and endoscopist were satisfied. Conclusion: remifentanil and Dexmedetomidine-based sedations during therapeutic ERCP in elderly helps to maintain the patient in a safe and more stable level of sedation and increases satisfaction of the anesthetist.