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内镜逆行胰胆管造影术(ERCP)中使用催眠加镇静镇痛与单纯镇静镇痛方法的比较:一项前瞻性随机研究。

Comparison of hypnosis plus sedoanalgesia and sedoanalgesia alone methods used in the ERCP procedure: A prospective randomized study.

作者信息

Arslan Ufuk, Özgünay Şeyda Efsun, Yiğit Direnç, Düzköylü Yiğit

机构信息

Department of Gastroenterological Surgery, Bursa NEV Hospital, Bursa, Turkey.

Department of Anesthesiology and Reanimation, Yuksek Ihtisas Teaching and Research Hospital, Bursa, Turkey.

出版信息

Medicine (Baltimore). 2025 Jun 6;104(23):e42641. doi: 10.1097/MD.0000000000042641.

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is an interventional procedure that is often performed under sedation anesthesia and that is used in the diagnosis and treatment of hepatopancreaticobiliary diseases. The objective of this study was to compare the efficacy of hypnosis in conjunction with sedoanalgesia and sedoanalgesia alone in the context of outpatient anesthesia prior to ERCP. Patients undergoing ERCP in the endoscopy unit between March and May 2021 were randomly assigned to 1 of 2 groups: group 1 received hypnosis and sedoanalgesia, and group 2 received sedoanalgesia alone. Both groups were administered 0.5 to 0.6 mg/kg intravenous pethidine hydrochloride (HCl), 1 to 3 mg intravenous midazolam, and 1 to 2 mg/kg intravenous propofol. The first group also received hypnotic induction before the procedure and anesthetic agents. In the event of patients exhibiting movement during the procedure, an anesthesiologist was unaware of the patient's allocation and administered additional propofol and/or pethidine HCl. A statistical comparison was conducted between the 2 groups regarding demographic data, vital parameters, medication requirements, and satisfaction scales. Thirty patients were included in both groups. Following the procedure, the administration of propofol and pethidine HCl was reduced in group 1 (P = .031 and P = .009, respectively). The 5-minute heart rate, baseline peripheral oxygen saturation at 3 and 10 minutes were lower in group 2 (P = .008, P = .011, P = .017, and P = .031, respectively). Although the dose of anesthetic drugs were lower, no significant difference was observed neither in the patient satisfaction scores, nor in patient movements. The use of hypnosis during ERCP enhances the efficacy of sedoanalgesia. Hypnotic anesthesia may be employed as an alternative method in cases where high-dose administration of these agents is contraindicated.

摘要

内镜逆行胰胆管造影术(ERCP)是一种常在镇静麻醉下进行的介入性操作,用于诊断和治疗肝胰胆疾病。本研究的目的是比较在ERCP术前门诊麻醉中,催眠联合镇静镇痛与单纯镇静镇痛的效果。2021年3月至5月间在内镜科接受ERCP的患者被随机分为两组:第1组接受催眠和镇静镇痛,第2组仅接受镇静镇痛。两组均静脉注射0.5至0.6 mg/kg盐酸哌替啶、1至3 mg咪达唑仑静脉注射和1至2 mg/kg丙泊酚。第一组在操作和使用麻醉剂前还接受了催眠诱导。如果患者在操作过程中出现活动,麻醉医生不知道患者的分组情况,并给予额外的丙泊酚和/或盐酸哌替啶。对两组的人口统计学数据、生命体征参数、药物需求和满意度量表进行了统计学比较。两组均纳入30例患者。操作后,第1组丙泊酚和盐酸哌替啶的用量减少(分别为P = .031和P = .009)。第2组5分钟心率、3分钟和10分钟时的基线外周血氧饱和度较低(分别为P = .008、P = .011、P = .017和P = .031)。尽管麻醉药物剂量较低,但患者满意度评分和患者活动方面均未观察到显著差异。ERCP术中使用催眠可提高镇静镇痛效果。在这些药物高剂量使用禁忌的情况下,催眠麻醉可作为一种替代方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8690/12150974/96708a768083/medi-104-e42641-g001.jpg

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