Clinical Observation Of Dexmedetomidine Composite With Propofol Or Etomidate Emulsion For Aged Patient Used In ERCP

It has a similar effect with the operation in diagnosis and treatment of some on biliary tract and pancreatic diseases by ERCP. So it was particularly important for the aged who have a higher risk in the surgery.Patients completed diagnosis and treatment during waking hours more at the beginning of the treatment of the development of the technology operation.Tension, anxiety,fear is inevitable,Plus put the body of endoscope, expansion of duodenal papilla, cut nipple ring, mechanical lithotripsy, nose bile duct placement Such as strong surgical stimulation in the process of operation,those often causes in patients with cough, nausea and vomiting, fast heart rate, increases blood pressure, arrhythmia such as high stress reaction,and Seriously will induce angina pectoris, myocardial infarction, stroke, or cardiac arrest such as serious complications.Another part of patients unable to tolerate and cooperate with ERCP examination, enabling clinicians to further clear nature of the disease, which affect the subsequent treatment and diagnosis.Painless ERCP examination treatment has become the trend of diagnosis and treatment of this disease with the constant improvement of the patients for medical service requirement.It not only can effectively eliminate or relieve patients, abdominal distention, nausea, vomiting such as subjective pain and discomfort in diagnosis and treatment in the process of pain, but also inhibit the operation of bile duct around the vagus nerve reflex, further reducing the occurrence of cardiovascular system of serious complications, thereby improve patient acceptance and safety of ERCP, and create better Diagnosis and treatment conditions for physicians. Due to the many of them who receive treatment with ERCP were the aged patients whose whole body has systemic complications more on the vital organs,and patients to be resettled in the special position with ERCP operation:Lateral position or prone position what directly compress the chest and abdomen, it will come into being obvious effects for breathing.In addition, the operation time is longer and stimulation is stronger in ERCP, therefore, it is very important to success that choosing the appropriate method, maintaining moderate depth of anesthesia to ensure patient safety and operation.Objective: To observe the clinical application effect of dexmedetomidine composite with Propofol or Etomidate emulsion for aged patient used in ERCP.Methods: 40 patients who needed ERCP were randomly divided into four groups:Propofol group(P group),Dexmedetomidine composite with propofol group(PD group), Etomidate emulsion group(E group),Dexmedetomidine composite with etomidate emulsion group(ED group).maintaining Narcotrend monitoring value at D0-D1 level. Record MAP, HR, Sp O2 value, ELISA method to detect plasma epinephrine(EPI), norepinephrine(NE) and the concentration of dopamine(DA) at these time before anesthesia induction(T0), endoscopic placement(T1), break through the duodenal papilla(T2), the nasal export of nose bile duct(T3) patients. Observe and record awakening time after the operation time, nausea and vomiting, incidence of restlessness, 24, 48, 72 hours of follow-up delirium occurrence.Results:1 There was no statistical difference in the general data of(Age, Sex ratio,Weight,Operative time)in four groups which is comparable( P >0. 05).2 Comparison of vital signsThere is no statistical difference between groups at T0 in MAP, HR and Sp O2(P>0.05);MAP comparison in the group: index of group E at T1,T2,T3 increased significantly than that at T0(P<0.05);Comparison between groups:index of group E at T1, T2 and T3 was significantly higher than those in other groups at the same time point,(P<0.05);HR comparison in the group: index of group E at T2,T3 was significantly higher than that at T0(P<0.05);Comparison between groups: index of group E at T3 was significantly higher than those in other groups at the same time point,(P<0.05);SPO2 comparison in the group: index of group P, group PD at T1 was significantly lower than that at T0(P<0.05);Comparison between groups:index of group P, group PD at T1 was significantly lower than those in other groups at the same time point,(P<0.05);3 Comparison of Stress hormonesEPI,NE,DA comparison in the group:index of group P, group E at T2,T3 was significantly higher than that at T0(P<0.05).index of group E at T1 was significantly higher than that at T0(P<0.05);Comparison between groups:EPI index of group P at T2,T3 was significantly higher than that in the group PD,ED at the same time point(P<0.05).EPI index of group E at T3 was significantly higher than that in the group PD,ED at the same time point(P<0.05);NE index of group P,group E at T3 was significantly higher than that in group PD,ED at the same time point(P<0.05);DA index of group E at T2 was significantly higher than that in other groups at the same time point(P<0.05),DA index of group ED was significantly higher than that in group PD at the same time point(P<0.05).4 Comparison of the adverse reactionsThe myoclonus incidence was 20% in E group(2 cases).It was significantly higher than that in other groups(P<0.05);The awaking time of patients in the etomidate group was significantly prolonged than that(P<0.05); There was no significant difference in incidence of nausea and vomiting,restlessness,delirium occurring between groups at postoperative(P>0.05).Conclusion: All the four methods can be as the anesthesia schemes safely and effectively for the aged patients.There is potential respiratory inhibition in Propofol group.The incidence rate of myoclonus is higher and awakening time extended in etomidate group.That dexmedetomidine composite with etomidate emulsion can decrease or lower the adverse reactions of etomidate emulsion,make the respiratory and circulatory more stable during operation, make the anesthetic effect be better,inhibit the high degree of stress reaction and have a higher Safety.It can be as the most ideal anesthesia schemes for aged patient in ERCP.