Clinical Study Of Propofol Combined With Hydromorphone For ERCP Anesthesia In Elderly Patients

Objective: To observe the clinical effect of target-controlled infusion of propofol combined with hydromorphone on elderly patients undergoing ERCP.Methods: Select 60 elderly patients who voluntarily received ERCP under general anesthesia from October 2017 to January 2019.Randomly divided into FP group(fentanyl 1.0 ?g / kg + propofol),HP group(hydromorphone 10.0 ?g / kg + propofol).Observe the patients' mean arterial pressure,heart rate,respiratory rate,blood oxygen saturation,and target-controlled infusion concentration at TO(Time to enter the interventional operating room),T1(time after the end of anesthesia induction),T2(time to enter the mouth with duodenoscope),T3(time to nipple incision),T4(time to take the basket),and T5(the time to call for response).Observe the body movements during the operation,the operation time,the recovery time of anesthesia.Observe the VAS analgesic score and LOS sedation score at 60 min after operation.Observe and record the incidence of complications such as cough,nausea and vomiting,and pharynx discomfort in both groups.Results: There were no significant difference in the general conditions between the two groups of patients(P> 0.05).Comparison of mean arterial pressure levels of T0,T1,T2,T3,T4 and T5 between two groups,the FP group was(103.7±8.21)mm Hg?(78.47±5.83)mmHg?(92.67±6.37)mm Hg?(102.13±5.11)mmHg?(84.4±4.89)mmHg?(106.77±12.51)mmHg.HP group is(101.98±8.63)mmHg?(82.79±6.14)mmHg?(92.6±5.54)mmHg?(97.99±4.99)mmHg?(86.79±4.48)mmHg?(101.7±10.15)mmHg.At time T1,the mean arterial pressure in the HP group was significantly higher than in the FP group,P <0.05.At time T3,HP group had lower mean arterial pressure than FP group,P <0.01.Comparison of heart rate changes at different time between two groups.The heart rate of T0,T1,T2,T3,T4 and T5 in FP group respectively were(80.97±6.87)times/min,(74.31±7.17)times/min,(85.52±5.58)times/min,(88.28±3.47)times/min,(75.1±5.23)times/min,(81.55±15.48)times/min;The heart rate of T0,T1,T2,T3,T4 and T5 in HP group were(81.13±6.6)times/min,(74.5±7.44)times/min,(85.73±5.66)times/min,(88.27±4.6)times/min,(75.43±3.75)times/min,(81.5±12.07)times/min;The heart rate in HP group was significantly lower than that in FP group at T3,P<0.05.There were no significant differences in respiratory frequency,blood oxygen saturation,target-controlled infusion concentration,number of intraoperative movements,operation time,and recovery time of anesthesia between the two groups,P>0.05.The VAS at 60 min after operation and LOS scores of the FP group were(3.14±0.94)points and(1.66±0.54)points respectively;the HP group was(1.77±0.67)points and(2.37±0.80)points respectively;HP group is significantly better than FP group,P<0.01.The incidence of choking reaction,nausea,vomiting,and pharynx discomfort in the FP group were 2(6.67%),2(6.67%),1(3.33%),and 3(10%),with a total incidence of 26.67 %;HP group were 0 cases(0.00%),1 case(3.33%),1 case(3.33%),0 cases(0.00%),with a total incidence of 6.67%.For the FP group,the HP group had more less incidence of adverse reactions,P <0.05.Conclusion: Target-controlled infusion of propofol combined with hydromorphone had better anesthetic effect and fewer side effects than that of propofol combined with fentanyl for ERCP in elderly patients.