目的，探讨不同麻醉药物复合异丙酚用于老年内镜逆行胰胆管造影患者术中的 （ERCP）安全性及可行性。 方法 择期行 ERCP 术的老年患者共 90 例，随机分成 A、B、C 三组，每组 30 例， A 组为单一使用异丙酚组；B 组为瑞芬太尼复合异丙酚组；C 组为地佐辛 加异丙酚联合组 ；其中 A 组以异丙酚诱导及维持；B 组以异丙酚诱导后异丙酚 复合瑞芬太尼共同维持；C 组以异丙酚及地佐辛诱导，诱导后亦异丙酚单一维 持 。术中分别观察并同时给以记录诱导前后、进镜时刻、术中操作、术后退镜 时刻及术毕完全苏醒等不同时间点的 SBP、HR、SpO 2 、 RR 及术毕完全苏醒的 时间及手术前后的相关不良反应发生情况,术中监测 BIS 值并记录 BIS 值控制于 55 时的异丙酚相关维持剂量。 结果，实验中所有患者均可较为顺利完成手术中的各种相关诊疗操作，A、B、 C 三组患者的 SBP、SpO 2 、RR 在诱导完后均显著低于麻醉诱导前期(P<0.01)， 组间比较:B、C 二组患者的 HR、SBP 在进镜时刻、术中操作、术后退镜时刻均 显著低于 A 组(P<0.05)；B、C 两组患者之间 RR、SpO 2 在进镜时刻、术中操作、 术后退镜时刻的各时点均显著高于 A 组(P<0.05)；而 B、C 两组之间同时间段的 HR、SBP、RR、SpO ２ 可无显著性差异（P>0.05）；B、C 两组各自与 A 组之间 平均清醒时间、异丙酚维持量、不良反应发生情况均有显著差异性(P<0.05),而 B、 C 二组之间的平均清醒时间、不良反应发生情况无显著差异(P>0.05)。 结论，瑞芬太尼复合异丙酚与地佐辛复合异丙酚均能更有效维持 ERCP 术中循 环血流动力学及呼吸的平稳，术中及术后不良反应少,可显著减少术中异丙酚维 持用量且术后患者更易苏醒,可作为老年患者 ERCP 术中安全的麻醉选择方式。 关键词， 异丙酚；老年患者；内镜逆行胰胆管造影；可行性研究III ABSTRACT Objective，To research the effectiveness and safety of different anesthetic drugs composite Propofol in elderly patients of endoscopic retrograde cholangio pancre- atography (ERCP). Methods，ninety ASAⅠorⅡpatients aged 60-87yr for elective ERCP were randomly divided into three groups with 30 patients each ， propofol group(group A), remifentanil combined with propofol group (group B) and Dezocine combined with propofol group (group C):those in group A were anesthetized with propofol while those in group B were anesthetized with remifentanil and propofol，in group C were anesthetized with Dezocine and propofol.HR，SBP，DPB,RR，SpO 2 were respectively recorded before and after anesthesia induction,start endoscope ， Intraoperative operation and finish endoscope intraoperation and revival ,the maintenance dose of propofol to keeping the BIS score nearby 55 in the operation，adverse effects and awakening time were also be recorded． Results，The patients of all groups were quiet and stable during the operation ．After induction，SBP，RR，SpO 2 in each group were lower than before induction P<0．01). Comparison among groups ,group B and group C , s HR，SBP was obviously lower than group A while group B and group C , s RR，SpO 2 was obviously Higher than group A during the monment of start endoscope Intraoperative operation and finish endoscope(P<0.05) , Betw-een group B and groupC there is no significant difference in HR ,SBP ,RR , SpO2 (P > 0.05，the waking time ，the maintenance dose of propofol and adverse effects in group B and group C are also obviously less than group A (P<0.05) ,while there is no difference between group B and group C (P>0.05). Conclusion，It is safe and available for remifentanil combined propofol and Dezocine combined with propofol in elderly patients of endoscopic retrograde cholangio pancreatography (ERCP) since both of the two anes-thesia method could maintain Haemodynamics stationary and breathing stable, less adverse effects and easy toIV revive,which are all effective and safety anesthesia method in elderly patients with endoscopic retro-grade cholangio pancreatography (ERCP). Key words ， propofol ； elderly patients ； Endoscopic retrograde eholangio Pancreatography; Feasibility study.V 目 录 第 1 章 引言...............................................................................................................1 第 2 章 实验材料.......................................................................................................3 2.1 实验药品 .........................................................................................................3 2.2 主要仪器设备 .................................................................................................3 2.3 其他相关抢救药品及器具 .............................................................................3 第 3 章 实验方法.......................................................................................................4 3.1 病例选择及分组 .............................................................................................4 3.2 麻醉方法 .........................................................................................................4 3.3 研究方法 .........................................................................................................5 3.4 监测指标 .........................................................................................................5 3.5 统计学处理 .....................................................................................................6 第 4 章 实验结果.......................................................................................................7 4.1 术中患者的一般情况 .....................................................................................7 4.2 临床监测指标的比较 .....................................................................................7 第 5 章 讨论.............................................................................................................12 5.1 ERCP 术中不同麻醉药物的各自相关药理学特点 .....................................12 5.1.1 丙泊酚的药理学特性 .........................................................................12 5.1.2 瑞芬太尼的药效特点 .........................................................................13 5.1.3 地佐辛的药效特性 .............................................................................14 5.2 临床麻醉中联合用药的特点 .......................................................................15 5.2.1 瑞芬太尼联合丙泊酚用于患者全凭静脉麻醉的研究讨论 .............15 5.2.2 地佐辛复合丙泊酚用于患者全凭静脉麻醉的相关研究讨论 .........16 5.3 脑电双频指数（BIS）在 ERCP 诊疗术中应用的意义 .............................17 5.4 老年患者 ERCP 手术麻醉的相关特点 .......................................................18 5.5 ERCP 等介入治疗中的医护人员自身防护相关问题 .................................18VI 第 6 章 实验结论与展望.........................................................................................20 6.1 实验结论 .......................................................................................................20 6.2 研究中的不足与展望 ...................................................................................20 致谢.........................................................................................................................21