Narcotrend麻醉深度监测下右美托咪定复合丙泊酚在ERCP中的应用探讨

蔡剑波　陈长江　马华斌

[摘要] 目的 探讨Narcotrend麻醉深度监测下右美托咪定复合丙泊酚在内镜下逆行胰胆造影（ERCP）中的应用效果。方法 选取200例胆管结石梗阻的患者。100例患者采用Narcotrend麻醉深度监测下麻醉（监测组），另100例凭经验无麻醉深度监测麻醉（未监测组）。两组患者常规给予右美托咪定复合丙泊酚下麻醉。比较两组患者的呼吸变化和循环变化情况、体动发生率、镇痛效果、丙泊酚总量、麻醉苏醒时间。结果 两组镇痛效果无明显差异（P>0.05）。监测组患者的呼吸变化、循环变化、体动发生率明显优于未监测组（P<0.05）；监测组丙泊酚总用量、苏醒时间更优于未监测组（P<0.05）。结论 Narcotrend麻醉深度监测下右美托咪定复合丙泊酚在ERCP中的应用效果确切，可有效减少丙泊酚的使用量，减少呼吸循环抑制、体动发生率，苏醒时间更短，能够做到精确麻醉，值得推广应用。

[关键词] Narcotrend麻醉深度监测；右美托咪定；丙泊酚；ERCP

[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2017）19-0105-03

[Abstract] Objective To investigate the effect of dexmedetomidine combined with propofol in endoscopic retrograde cholangiopancreatography（ERCP） under Narcotrend anesthesia depth monitoring. Methods A total of 200 patients with obstruction of the common bile duct by stones were selected. 100 patients were administered under Narcotrend anesthesia depth monitoring（monitoring group） and the other 100 patients were administered by experience without Narcotrend anesthesia depth monitoring（non-monitoring group）. Two groups of patients were routinely given dexmedetomidine combined with propofol. The respiratory changes and circulatory changes， the incidence of body movement， the analgesic effect， the total amount of propofol and the awakening time of anesthesia were compared between the two groups. Results There was no significant difference in analgesic effect between the two groups（P>0.05）. The respiration change， cycle change and body movement rate were significantly higher in monitoring group than those in non-monitoring group（P<0.05）.The total dose of propofol and recovery time in monitoring group were better than those in non-monitoring group（P<0.05）. Conclusion The dexmedetomidine combined with propofol in ERCP under Narcotrend anesthesia depth monitoring has exact application effect， which can reduce the use of propofol effectively， the rate of respiratory cycle and the incidence of body motion， with shorter recovery time. And it can ensure the accurate anesthesia， which is worthy of promotion and application.

[Key words] Narcotrend anesthesia depth monitoring； Dexmedetomidine； Propofol； ERCP

逆行胰膽管造影为胰胆疾病重要的检查和治疗手段。由于ERCP患者术中有明显不适感，会产生体动，影响医生手术操作，增加了围术期风险。加上手术时间较长，单凭不插管的静脉麻醉深度难于把握，需选择合适的麻醉方法，以提高镇痛镇静效果和患者依从性[1-3]。本研究分析了Narcotrend麻醉深度监测下右美托咪定复合丙泊酚在ERCP中的应用效果，现报道如下。

1 资料与方法

1.1 一般资料

选取200例胆管结石梗阻的患者，其中100例患者用Narcotrend麻醉深度监测下给药（监测组），100例凭经验无麻醉深度监测给药（未监测组）。纳入标准：所有患者均符合胆管结石梗阻诊断标准，无丙泊酚和右美托咪定禁忌。所有患者ASA为Ⅱ～Ⅲ级。排除标准：不符合胆管结石梗阻诊断标准；有丙泊酚和右美托咪定禁忌；ASA为Ⅳ级；不配合治疗者。监测组患者男58例，女42例；年……