老年人实施镇静性上消化道内镜术的特点  

The eddiracy and savety of using sadatives during upper gastrointestinal endoscopic procedure in elderly persons

作　　者：王芬[1] 沈守荣[1] 欧阳文[2] 徐灿霞[1] 唐五良[1] 王晓艳[1] 肖定华[1] 

机构地区：[1]中南大学湘雅三医院消化内科,长沙市410013 [2]中南大学湘雅三医院麻醉科,长沙市410013

出　　处：《中华老年医学杂志》2007年第11期813-815,共3页Chinese Journal of Geriatrics

基　　金：湖南省社会发展科技项目（02ssy3081）

摘　　要：目的探讨老年人实施镇静性上消化道内镜术的镇静特点。方法将344例接受镇静性上消化道内镜术患者分为老年组（146例）及青中年组（198例），内镜检查术前均予咪达唑仑0．02～O．05mg／kg，丙泊酚0．5～2．5mg／kg，术中酌情追加丙泊酚用量。结果内镜术前及术中，老年组应用咪达唑仑（1．3±0．2）mg、丙泊酚（64．3±13．1）mg，均显著低于青中年组（1．6±0．2）mg及（72．4±15．0）mg（P〈0．01）；操作者评估老年组镇静质量明显高于青中年组（P〈0．01）；老年组术前、术中及术后血压（收缩压／舒张压）分别为（118．7±24．7）／（63．4±10．1）mmHg、（98．8±20．7）／（57．9±11．2）mmHg和（101．7±21．5）／（58．5±10．4）mmHg，青中年组分别为（110．6±23．3）／（63．0±11．1）mmHg、（95．5±19．8）／（57．9±9．9）mmHg和（96．1±21．2）／（57．0±9．8）mmHg，差异均有统计学意义（P〈0．01），但两组之间变化程度比较，差异无统计学意义；两组严重不良事件发生率比较，差异无统计学意义。结论在实施镇静性上消化道内镜术时，老年组对咪达唑仑、丙泊酚更敏感，用量较青中年人群明显减少，使用较安全，且镇静质量较好，内镜操作过程顺利。Objective To investigate the efficacy and savety of using medication of midazolam and propofol for sedation during upper gastrointestinal endoscopic procedures in the elderly. Methods Three hundred and forty-four outpatients undergoing gastroscopy were assigned to two groups： elderly group（n= 146,aged 60-82 yrs） and younger adult group（n= 198,aged 18-59 yrs）. All the patients were premedicated with midazolam 0. 02-0. 05 mg/kg iv. and propofol 0. 5-2.5 mg/kg iv. Pulse rate, arterial pressure and oxygen saturation were obtained for each patient and monitored continuously before, during and after the procedure. All patients received supplemental oxygen during the procedure. Results The dose of midazolam and propofol required were decreased markedly in elderly group[（ 1.3 ± 0. 2） mg, （64.3 ± 13.1 ） mg] than in younger adult group [- （1.6 ± 0. 2） mg, （72.4±15. 0）mg] （P〈0. 01）. All patients showed high satisfaction with sedation and anesthesia. According to staff gastroenterologists, the satisfaction rate of sedation quality was significantly higher in elderly group than in younger group（97.9% vs. 90. 4%, P〈0. 01）. SBP of elderly group and younger adult group before, during and after the procedure were （118. 7 ± 24.7） mm Hg vs. （110. 6±23.3） mm Hg,（98. 8±20. 7） mm Hg vs. （95. 5±19.8）mm Hg and （101.7±21.5） mm Hg vs. （96.1±21.2）mm Hg respectively. DBP of elderly group and younger adult group before, during and after the procedure were （63. 4±10. 1） mm Hg vs. （63.0±11. 1） mm Hg,（57.9±11.2）mm Hg vs. （57. 9± 9. 9） mm Hg, （58. 5 ± 10. 4） mm Hg vs. （57.0± 9.8） mm Hg respectively. There were significant differences in of arterial pressure in both groups（all P〈0. 01）, but the differences were not marked in elder group compared with younger group（P〉0. 05）. Clinically important changes between elderly group and younger group were not statistically significant（P〉0. 05）. Conclusions Elderly persons are more sensit

关 键 词：内窥镜检查 胃肠道 咪达唑仑 二丙泊酚 安定镇痛 

分 类 号：R686[医药卫生—骨科学]