右美托咪定复合丙泊酚或依托咪酯在高龄患者ercp术中的临床观察

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1、授予单位代码10089学号或申请号20122189对妗(E钭大2HebeiMedicalUniversity硕士学位论文科学学位右美托咪定复合丙泊酚或依托咪酯在高龄患者ERCP术中的临床观察研究生：杨幼明导师：徐雪副教授专业：麻醉学二级学院：第二医院2015年3月河北医科大学学位论文使用授权及知识产权归属承诺本学位论文在导师（或指导小组）的指导下，由本人独立完成。本学位论文研究所获得的研究成果，其知识产权归河北医科大学所有。河北医科大学有权对本学位论文进行交流、公开和使用。凡发表与学位论文主要内容相关的论文，第一署名为单位河北医科大学，试验材料、原

2、始数据、申报的专利等知识产权均归河北医科大学所有。否则，承担相应法律责任。‘i研究生签名:炎^4导师签章：六^二级学院领导盖章：J/“宇乾月夸-日'V..i河北医科大学研究生学位论文独创性声明本论文是在导师指导下进行的研究工作及取得的研究成果，除了文中特别加以标注和致谢等内容外，文中不包含其他人己经发表或撰写的研究成果，指导教师对此进行了审定。本论文由本人独立撰写，文责自负。研究生签名：导师签章：{弋作年>月日•目录中文摘要······························································

3、···············1英文摘要·············································································3英文缩写·············································································7研究论文右美托咪定复合丙泊酚或依托咪酯在高龄患者ERCP术中的临床观察前言····························································

4、·················8材料与方法····································································10结果·············································································16附表·············································································17讨论····················

5、·························································20结论·············································································23参考文献·······································································24综述··························································

6、·························26致谢···················································································36个人简历············································································37中文摘要右美托咪定复合丙泊酚或依托咪酯在高龄患者ERCP术中的临床观察摘要经内镜逆行胰胆管造影术（ERCP）在诊断、治疗一些胆道、胰源性疾病上具有与手术类似的效果

7、，因此在手术风险较高的老年人中显得尤为[1-2]重要，该项技术操作的发展治疗初期患者多在清醒状态下完成诊疗，不可避免的会产生紧张、焦虑和恐惧等心理过程，加上检查操作过程中的置入镜体、扩张十二指肠乳头、切开乳头环形肌、机械碎石、鼻胆管置入引出等较强的手术刺激，患者常会产生咳嗽，恶心呕吐，血压升高，心率增快和心律失常等伤害性应激反应，严重的甚至会诱发心肌梗死，脑卒中或者心搏骤停。另有一部分患者由于无法耐受和配合ERCP检查，从而使临床医师无法进一步明确疾病性质，影响后续的治疗和诊断。随着患者对医疗服务要求的不断提高，无痛ERCP检查治疗已成为该项疾病诊

8、治的趋势，诊疗过程中它不仅能够有效的消除或减轻患者所产生的疼痛，腹胀和恶心呕吐等主观痛苦与不适感，还可抑制手术操作引发的胆