Yang Yu-Guang, Hu Liang-Hao, Chen Hui, Li Bo, Fan Xiao-Hua, Li Jin-Bao, Wang Jia-Feng, Deng Xiao-Ming
Department of Anesthesiology and Intensive Care, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433, PR China.
Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, 200433, PR China.
BMC Anesthesiol. 2015 Nov 7;15:161. doi: 10.1186/s12871-015-0141-6.
Extracorporeal shock wave lithotripsy (ESWL) is an effective therapeutic method used to treat patients with pancreatic stones. However, the anesthesia for this procedure has been underappreciated, with minimal reports of these procedures in certain case series with general or epidural anesthesia.
A cohort of 60 patients who elected to undergo ESWL in order to treat pancreatic stones for the first time were randomly selected and divided into two groups. One group of patients received target controlled infusion (TCI) of remifentanil, while the other group of patients received TCI of remifentanil plus a bolus of flurbiprofen axetil (a cyclooxygenase inhibitor) (Rem group and Rem + Flu group, n = 30 for each group). The Dixon's up-and-down method was used to calculate the half maximum effective concentration (EC50) of remifentanil. Visual analogue scales of pain, Ramsay sedation scale, hemodynamic changes, and adverse events were also recorded.
The EC50 of remifentanil was calculated to be 4.0 ng/ml (95 % confidential interval: 3.84 ng/ml, 4.16 ng/ml) and 2.76 ng/ml (95 % confidential interval: 2.63 ng/ml, 2.89 ng/ml) in the Rem group and Rem + Flu group respectively (p < 0.001). Pain score was comparable between the two groups, while the Ramsay sedation scale was higher in the Rem group. Hemodynamic data showed that patients in the Rem group experienced higher mean arterial pressures and higher heart rates across the procedures. Patients in Rem group demonstrated a lower respiratory rate (p < 0.001) and a lower SpO2 (p = 0.001). Less adverse events occurred in Rem + Flu group, including a reduced respiratory depression requiring wake-up as well as reduced postoperative nausea and vomiting.
Remifentanil plus flurbiprofen axetil provided satisfactory analgesia and sedation for ESWL of pancreatic stones with less adverse events. (Clinicaltrial.gov: NCT01998217 ; registered on November 19, 2013).
体外冲击波碎石术（ESWL）是治疗胰腺结石患者的一种有效治疗方法。然而，该手术的麻醉一直未得到充分重视，在某些采用全身麻醉或硬膜外麻醉的病例系列中，关于这些手术的报道极少。
随机选取60例首次因治疗胰腺结石而选择接受ESWL的患者，分为两组。一组患者接受瑞芬太尼靶控输注（TCI），另一组患者接受瑞芬太尼TCI加一剂氟比洛芬酯（一种环氧化酶抑制剂）（瑞芬组和瑞芬+氟比洛芬组，每组n = 30）。采用 Dixon 上下法计算瑞芬太尼的半数有效浓度（EC50）。还记录了疼痛视觉模拟量表、Ramsay 镇静量表、血流动力学变化及不良事件。
瑞芬组和瑞芬+氟比洛芬组瑞芬太尼的 EC50 分别计算为 4.0 ng/ml（95%可信区间：3.84 ng/ml，4.16 ng/ml）和 2.76 ng/ml（95%可信区间：2.63 ng/ml，2.89 ng/ml）（p < 0.001）。两组疼痛评分相当，但瑞芬组 Ramsay 镇静量表评分更高。血流动力学数据显示，瑞芬组患者在整个手术过程中平均动脉压更高、心率更快。瑞芬组患者呼吸频率更低（p < 0.001）、血氧饱和度更低（p = 0.）。瑞芬+氟比洛芬组不良事件更少，包括需要唤醒的呼吸抑制减少以及术后恶心呕吐减少。
瑞芬太尼加氟比洛芬酯为胰腺结石ESWL提供了满意的镇痛和镇静效果，且不良事件较少。（Clinicaltrial.gov：NCT01998217；于2013年11月19日注册）
