| Purpose:To compare the differences between sedative effects when using butorphanol and sufentanil in combination with propofol in ERCP,and to find an analgesic drug that is most suitable for use in ERCP surgery in combination with propofol.Method:Collecting 96 patients undergoing ERCP surgery in China-Japan Union Hospital of Jilin University?CJUH?.All patients are between 30-70 years old.The American Society of Anesthesiologists preoperative patient grading?ASA grade? of each patient is ?-?.The patients were randomly divided into three groups:saline group?group A?,butorphanol group?group B?and sufentanil group?group C?,32 patients in each group,All patients were sedated by intravenous infusion of propofol.Monitor vital signs after entering the operating room.The patient was given a nasal catheter for oxygen inhalation at a flow rate of 3 to 5L/min.The operation was performed in a prone position,with a soft pillow under the right chest before starting the administration.Turn the patient's head to the right and wear a cushion for the surgeon to operate.When ready,each group of patients was given a slow intravenous bolus:0.9%saline 2 ml?Group A?,10 ?g/kg Butorphanol?Group B?,and 0.1 ?g/kg Sufentanil?Group C?.After 3 minutes,the propofol injection was slowly injected intravenously at 1.9 to 2.3 mg/kg.After the patient's consciousness disappeared and the eyelash reflex disappeared,the operation was started.During the operation,a micro pump was used to pump propofol at a rate of 4-6 mg·kg-1·h-1 to maintain sedation.If there are physical activity or other signs of waking up during the operation,rapid intravenous injection of propofol 20?40mg.The pumping of propofol was stopped immediately after the ERCP operation.After waking up,the patient was pushed into the observation room for 30 minutes,waiting for the patient to be conscious,and returned to the ward without obvious other discomfort.The information to be recorded and observed during the experiment is:general information such as patient name,gender,age,weight,etc.;Vital signs include changes in fingertip blood oxygenation?SP02?,heart rate?HR?,and mean arterial pressure?MAP?at TO?patient into the operating room?,T1?after receiving saline/butorphanol/sufentanil?,T2?after completion of induction?,T3?via oral cavity?,T4?cutting duodenal papilla?,T5?after surgery,after retraction?,T6?patient waking,recovery after consciousness?;The number of adverse reactions such as cough,intraoperative body movement,hypoxemia,respiratory depression,blood pressure fluctuations,heart rate fluctuations,postoperative nausea and vomiting,dry mouth,etc.;operation time,recovery time?from withdrawal to patient waking?,the total amount of propofol and the satisfaction of the patient and the surgeon on the sedative effect.Result:There was no statistically significant difference in the general information between the three groups?P>0.05?.There was no significant difference in adverse reactions between the groups?P>0.05?.Changes in MAP of each group:MAP of each group had a slight decrease after administration,and propofol continued to decrease after induction,but there was fluctuation after the start of operation.After the patient awakens,the MAP recovers to a level close to that when entering the operating room.The difference of MAP with time in group A,group B and group C was statistically significant?P<0.05?.Comparison between the three groups:MAP difference between T3 and T4 was statistically significant?P<0.05?.There was no significant difference in MAP between the three groups at the other time points?P>0.05?.Comparison of HR changes in each group:It can be observed that there was no significant change in HR of group A after administration,and there was a significant decrease after induction.Group B and group C showed significant decline after administration,and continued to decrease after induction.The three groups experienced varying degrees of HR fluctuations during the operation and slowly recovered after the patient awake.The changes of HR in group A,group B and group C were statistically significant?P<0.05?.There was a statistically significant difference in HR between the three groups at T3,T4,and T5?P<0.05?.The difference in SP02 over time in the three groups of patients was significant.Comparison between the three groups:the contrast between T1 and T6 was significantly different?P<0.05?.There was no significant difference in the difference between the wake-up time and the total amount of propofol used between the three groups?P>0.05?.Conclusion:Butorphanol combined with propofol and sufentanil combined with propofol for sedation of ERCP is safe and reliable. |
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