年龄对成年患者丙泊酚单镇静无痛胃镜检查安全性的影响  

The influence of age on the safety of propofol mono-sedation gastroscopy for adult patients

作　　者：邵刘佳子[1] 万磊[1] 刘邵华[1] 刘缚鲲[1] 薛富善 Shao Liujiazi;Wan Lei;Liu Shaohua;Liu Fukun;Xue Fushan(Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院麻醉科,100050

出　　处：《中华消化内镜杂志》2021年第6期465-470,共6页Chinese Journal of Digestive Endoscopy

基　　金：中华医学会消化内镜学分会麻醉协作组"人福"科研基金(CSDE022020090001)。

摘　　要：目的探讨年龄对成年患者丙泊酚单镇静无痛胃镜检查安全性的影响。方法回顾性纳入321例实施择期丙泊酚单镇静方案无痛胃镜检查的成年患者,根据年龄段分为青年(18~44岁)组116例、中年(45~59岁)组103例和老年(60~80岁)组102例,观察无痛胃镜检查操作时间、丙泊酚用量、气道梗阻发生率、低氧血症发生率、气道干预措施(托下颌、面罩通气)应用率、最低血氧饱和度(SpO_(2)),以及不良心血管事件(高血压、低血压、心动过速、心动过缓)发生率和麻黄碱应用率。结果丙泊酚用量青年组为(173.2±47.0)mg、中年组为(158.8±41.3)mg、老年组为(137.8±26.3)mg,3组间比较差异有统计学意义(F=21.761,P<0.001),其中老年组丙泊酚用量明显少于中年组(P<0.017)和青年组(P<0.017),中年组丙泊酚用量明显少于青年组(P<0.017);低氧血症发生率青年组为12.9%(15/116)、中年组为15.5%(16/103)、老年组为25.5%(26/102),3组间比较差异有统计学意义(χ^(2)=5.711,P=0.017),其中老年组低氧血症发生率明显高于中年组(P<0.017)和青年组(P<0.017);低血压发生率青年组为5.2%(6/116)、中年组为4.9%(5/103)、老年组为11.8%(12/102),心动过缓发生率青年组为1.7%(2/116)、中年组为2.9%(3/103)、老年组为7.8%(8/102),总体不良心血管事件发生率青年组为11.2%(13/116)、中年组为10.7%(11/103)、老年组为20.6%(21/102),3组间比较差异均无统计学意义(P>0.05),但老年组低血压、心动过缓和总体不良心血管事件发生率有增高趋势。其他观察指标3组间比较差异均无统计学意义(P>0.05)。结论对于实施丙泊酚单镇静无痛胃镜检查的成年患者,随着患者年龄增大丙泊酚用量逐渐减少,在低氧血症发生率增高的同时,伴有总体不良心血管事件增多趋势,导致丙泊酚单镇静无痛胃镜检查的安全性逐步降低。Objective To assess the influence of age on the safety of propofol mono-sedation for adult patients undergoing painless gastroscopy.Methods A retrospective study was conducted on data of 321 patients scheduled for painless gastroscopy with propofol mono-sedation.According to the age,patients were divided into youth group(116 cases,18-44 years),middle-aged group(103 cases,45-59 years)and elderly group(102 cases,60-80 years).The procedure time,the total dosage of propofol,the occurrence of airway obstruction or hypoxemia,the use of airway interventions including airway opening maneuvers and facemask ventilation,lowest SpO_(2),adverse cardiovascular events(including hypertension,hypotension,tachycardia,and bradycardia),and the use of ephedrine during painless gastroscopy were observed.Results There was significant difference regarding the total dosage of propofol among youth group(173.2±47.0 mg),middle-aged group(158.8±41.3 mg)and elderly group(137.8±26.3 mg)(F=21.761,P<0.001).The total dosage of propofol was significantly lower in the elderly group compared with the middle-aged group(P<0.017)and youth group(P<0.017),and that in the middle-aged group was significantly lower than that in the youth group(P<0.017).The incidence of hypoxemia was 12.9%(15/116)in the youth group,15.5%(16/103)in the middle-aged group and 25.5%(26/102)in the elderly group,with significant difference among three groups(χ^(2)=5.711,P=0.017).Moreover,the incidence of hypoxemia was significantly higher in the elderly group compared with the middle-aged group(P<0.017)and youth group(P<0.017).The incidences of hypotension,bradycardia and total adverse cardiovascular events were 5.2%(6/116),4.9%(5/103)and 11.8%(12/102),1.7%(2/116),2.9%(3/103)and 7.8%(8/102),and 11.2%(13/116),10.7%(11/103)and 20.6%(21/102)respectively in youth,the middle-aged and the elderly group.There were no significant differences in the above indicators among the three groups(P>0.05).However,compared with those of the young and the middle-aged patients,the occurrence of hy

关 键 词：年龄因素 无痛胃镜 丙泊酚单镇静 低氧血症 不良心血管事件 

分 类 号：R614[医药卫生—麻醉学]