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病人自控镇静用于ERCP:一项随机双盲的阿芬太尼和瑞芬太尼的比较

发布日期:2014-1-29 12:40:46 文章来源:ENDOSCOPY 作者次数:1497
    病人自控镇静用于ERCP:一项随机双盲的阿芬太尼和瑞芬太尼的比较

    M. Mazanikov1, M. Udd2, L. Kylänpää2, H. Mustonen2, O. Lindström2, J. Halttunen2, M. Färkkilä3, R. Pöyhiä1

    1芬兰赫尔辛基大学中心医院麻醉和重症监护医学系

    2芬兰赫尔辛基大学中心医院胃肠和普外科

    3芬兰赫尔辛基大学中心医院肠胃科

    背景与研究目的:由患者自我给予异丙酚和阿片类药物的混合物(患者自控镇静,PCS)可在内镜逆行胰胆管造影期间为个人镇静提供一种实用的可替换的方法。然而,目前还不清楚什么是最适合PCS镇静的混合物。本研究目的是比较ERCP期间患者自控镇静所用的瑞芬太尼和阿芬太尼。

    患者和方法:三种不同方案中,81例经历择期内镜逆行胰胆管造影的患者接受了异丙酚和阿片类药物镇静下的PCS瑞芬太尼组(R)中镇静混合物中阿片类药物的浓度为0.02 mg/mL,而阿芬太尼1A1)和阿芬太尼2A2)组中阿片类药物浓度分别为0.04 mg/mL 0.08 mg/mL。同时我们将输注泵调整为一次剂量1 mL,且无锁定时间。如果未出现因镇静相关并发症所致手术中断或不需额外使用异丙酚,则我们认为该PCS是成功的。我们对异丙酚消耗量进行了登记,而且还对镇静水平和生命体征进行了检测。同时,我们也采用结构式问卷对内镜师和病人对镇静满意度进行了评估。

    结果:组R中异丙酚消耗量(SD)为177105mg,组A1A2 中异丙酚消耗量分别为19788mg16270mg。在81次镇静中,有74次成功达到PCS,且各组在异丙酚消耗量、镇静成功率、镇静水平、生命体征、术后疼痛和内镜师与患者满意度方面无差异。据观察,瑞芬太尼组比阿芬太尼组发生呼吸抑制和恶心的频率更高(P < 0.05)。

    结论:为行内镜逆行胰胆管造影,病人自控镇静是一种人们可接受的镇静方法。而且因为瑞芬太尼-异丙酚混合物对自主呼吸抑制较频繁,且会频繁地引发恶心并发症,所以我们推荐联合使用异丙酚和阿芬太尼。

     


    Patient-controlled sedation for ERCP: a randomized double-blind comparison of alfentanil and remifentanil

    M. Mazanikov1, M. Udd2, L. Kylänpää2, H. Mustonen2, O. Lindström2, J. Halttunen2, M. Färkkilä3, R. Pöyhiä1

    1Department of Anesthesia and Intensive Care Medicine, HelsinkiUniversityCentralHospital,Helsinki,Finland

    2Department of Gastrointestinal and General Surgery,HelsinkiUniversityCentralHospital,Helsinki,Finland

    3Department of Gastroenterology,HelsinkiUniversityCentralHospital,Helsinki,Finland

    Background and study aims: Self-administration of a propofol and opioid mixture by patients (patient-controlled sedation, PCS) could offer a practical alternative for individual sedation during endoscopic retrograde cholangiopancreatography (ERCP). However, what would be the most suitable sedative mixture for PCS is unknown. The aim of this study was to compare remifentanil and alfentanil in the PCS during ERCP.

    Patients and methods: Eighty-one patients undergoing elective ERCP received PCS with propofol and opioid in three different regimens. The concentrations of opioids in the sedative mixture were 0.02 mg/mL in the remifentanil group (R) and 0.04 mg/mL and 0.08 mg/mL in the alfentanil 1 (A1) and alfentanil 2 (A2) groups, respectively. The infusion pump was adjusted to deliver a 1 mL single dose with zero lockout time. We considered PCS as successful if no procedure interruption due to sedation-related complications occurred or if additional propofol was not needed. The consumption of propofol was registered, and sedation levels and vital signs were monitored. Endoscopist and patient satisfaction with sedation were assessed using structured questionnaires.

    Results: The consumption (SD) of propofol was 177 (105)mg in group R, 197 (88) mg in group A1 and 162 (70)mg in group A2. PCS was successful in 74 /81 (91 %) of sedations, without differences between the groups in terms of propofol consumption, sedation success rate, sedation levels, vital signs, postprocedural pain, and endoscopist and patient satisfaction. Respiratory depression and nausea were observed more frequently with remifentanil than with alfentanil (P < 0.05).

    Conclusions: PCS is an acceptable method of sedation for ERCP. The combination of propofol and alfentanil should be recommended because a remifentanil - propofol mixture depresses spontaneous respiration more and produces nausea more frequently.

     

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