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目的探讨老年患者无痛内镜下逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)的主要不良反应及其发生的危险因素。方法静脉麻醉辅助下行ERCP诊治的老年患者126例,观察ERCP围术期血压、心率、呼吸频率、血氧饱和度(blood oxygen saturation,SpO2)等变化以及不良反应发生情况;采用多因素logistic回归分析主要不良反应发生的危险因素。结果126例患者ERCP术中收缩压[(107.2±10.6)mm Hg]、SpO2[(89.70±0.38)%]均较术前[(120.8±12.5)mm Hg、(98.80±0.56)%]明显降低(P<0.05),术前、术中及术后舒张压、心率、呼吸频率比较差异均无统计学意义(P>0.05);术中并发低氧血症(SpO2<90%)47例(37.3%),血压下降22例,心动过缓3例,恶心呕吐及呛咳各1例;多因素logistic回归分析结果显示,年龄≥80岁(OR=5.309,95%CI:1.987~14.186,P=0.000)、吸烟≥10支/d且30a以上(OR=5.447,95%CI:2.075~14.300,P=0.000)、饮酒≥40g/d且20a以上(OR=3.563,95%CI:1.183~10.731,P=0.000)、体质量指数≥30kg/m2(OR=23.833,95%CI:2.296~191.702,P=0.000)、合并慢性阻塞性肺疾病(OR=8.308,95%CI:3.162~21.824,P=0.000)、丙泊酚用量≥280mg(OR=3.773,95%CI:1.708~8.336,P=0.000)、操作时间≥2h(OR=4.993,95%CI:2.117~11.777,P=0.000)是老年患者无痛ERCP发生低氧血症的危险因素。结论低氧血症是老年患者无痛ERCP术中的主要不良反应,高龄(≥80岁)、长期大量吸烟(≥10支/d且在30a以上)、长期大量饮酒(≥40g/d且在20a以上)、高体质量指数(≥30kg/m2)、合并慢性阻塞性肺疾病、丙泊酚用量大(≥280mg)、操作时间长(≥2h)是其发生的危险因素。
Objective To investigate the main adverse reactions and their risk factors of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients. Methods A total of 126 senile patients undergoing ERCP with intravenous anesthesia were enrolled in this study. The changes of blood pressure, heart rate, respiratory rate, blood oxygen saturation (SpO2) and the incidence of adverse reactions during ERCP were observed. Multivariate logistic regression analysis The main risk factors for adverse reactions. Results The systolic pressure of ERCP was significantly lower in the 126 patients (107.2 ± 10.6 mm Hg) and SpO2 (89.70 ± 0.38%) than that in the preoperative group (120.8 ± 12.5 mm Hg, (98.80 ± 0.56)%] (P0.05) .There was no significant difference in preoperative, postoperative and postoperative diastolic blood pressure, heart rate and respiratory rate (P> 0.05). There were 47 cases with hypoxemia (SpO2 <90%) 37.3%), blood pressure decreased in 22 cases, bradycardia in 3 cases, nausea, vomiting and cough in 1 case. Multivariate logistic regression analysis showed that age ≥80 years (OR = 5.309, 95% CI: 1.987-14.186, P (OR = 5.447, 95% CI: 2.075-14.300, P = 0.000), alcohol consumption≥40g / d and above 20a (OR = 3.563, 95% CI: 1.183 ~ (OR = 8.308, 95% CI: 3.162-21.824, P = 0.000), body mass index≥30kg / m2 (OR = 23.833,95% CI: 2.296-191.702, P = 0.000) with chronic obstructive pulmonary disease , P = 0.000), the dosage of propofol≥280mg (OR = 3.773,95% CI: 1.708 ~ 8.336, P = 0.000) and the operation time≥2h (OR = 4.993,95% CI: 2.117 ~ 11.777, P = 0.000 ) Is a risk factor for hypocholesterolemia in elderly patients with painless ERCP. Conclusion Hypoxemia is the main adverse reaction in elderly patients with painless ERCP. The elderly patients (≥80 years), long-term smoking (≥10 cigarettes / d and over 30 years), long-term heavy drinking (≥40g / d and 20a), high body mass index (≥30kg / m2), chronic obstructive pulmonary disease (COPD), large dosage of propofol (≥280mg) and long time of operation (≥2h) are the risk factors.