单次静脉注射阿芬太尼或芬太尼辅助丙泊酚TCI对老年患者无痛肠镜检查认知功能的影响  

Comparison of the effects of single intravenous infusion of alfentanil or fentanyl combined with closed‑loop target‑controlled infusion of propofol on cognitive function in elderly patients after painless colonoscopy

作　　者：王苗苗 毛立科 韩雪敏[1] 鲁显福[2] Wang Miaomiao;Mao Like;Han Xuemin;Lu Xianfu(Department of Anesthesiology,Huaibei People's Hospital,Huaibei 235000,China;Department of Anesthesiology(High‑Tech Branch),the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]淮北市人民医院麻醉科,235000 [2]安徽医科大学第一附属医院高新院区麻醉科,合肥230022

出　　处：《国际麻醉学与复苏杂志》2021年第12期1285-1290,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：目的评估阿芬太尼或芬太尼联合丙泊酚对老年患者无痛肠镜检查认知功能的影响。方法选择2019年3月至2020年10月于淮北市人民医院行无痛肠镜检查的老年住院患者106例,通过计算机生成随机序列将患者分为阿芬太尼组(AP组,52例)和芬太尼组(FP组,54例)。AP组和FP组患者分别缓慢静脉注射阿芬太尼5μg/kg或芬太尼0.5μg/kg,继之予以BIS监测下丙泊酚靶控输注(target controlled infusion,TCI)(BIS值设定55)。检查退镜至直肠时即停止丙泊酚TCI。记录患者一般情况、检查前30 min阿姆斯特丹术前焦虑和信息需求评分(Amsterdam Preoperative Anxiety and Information Scale,APAIS)、检查时间、清醒时间、离院时间、丙泊酚用量及有无低血压、呼吸暂停等不良事件发生情况,评估并记录检查前、离院时、出院后1 d和出院后3 d蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评分,数字分级评分法(Numerical Rating Scale,NRS)评估出院时患者腹痛情况,李克特量表评估医师满意度和患者满意度。结果两组患者一般情况、检查前30 min APAIS、丙泊酚用量、检查时间、NRS疼痛评分、医师及患者满意度比较差异均无统计学意义(P>0.05)。AP组清醒时间、离院时间较FP组降低(P<0.05)。两组患者离院时MoCA评分较检查前降低(P<0.05),AP组MoCA评分高于FP组(P<0.05);其他时点两组MoCA评分比较差异无统计学意义(P>0.05)。AP组患者术后恶心呕吐、呼吸暂停发生率低于FP组(P<0.05),其他并发症两组差异无统计学意义(P>0.05)。结论单次静脉注射阿芬太尼较单次静脉注射芬太尼联合丙泊酚TCI更有优势,对老年患者无痛肠镜检查术后认知功能的影响更小,麻醉后恢复质量更好。Objective To evaluate the effect of alfentanil or fentanyl combined with propofol on the postoperative cognitive function of elderly patients after painless colonoscopy.Methods A total of 106 elderly patients who underwent painless colonoscopy at Huaibei People's Hospital from March 2019 to October 2020 were enrolled.According to random sequences generated by computer,the patients were divided into two groups:an alfentanil(AP)group and a fentanyl(FP)group.Patients in the AP and FP groups were slowly intravenously injected with 5μg/kg alfentanil or 0.5μg/kg fentanyl,followed by closed‑loop target‑controlled infusion of propofol under bispectral index(BIS)monitoring(BIS=55).The infusion of propofol was stopped when the lens moved to the rectum.The following information was collected:general information,the Amsterdam Preoperative Anxiety and Information Scale(APAIS),check‑up time,awaking time,discharge time,propofol dosage and the presence of hypotension,respiratory depression and other adverse reactions.Their Montreal Cognitive Assessment(MoCA)scores were evaluated before examination,before discharge,1 day after operation,and 3 days after operation.Patient's abdominal pain before discharge was assessed by the Numerical Rating Scale(NRS)scores.The Likert scale was used to assess physician satisfaction and patient satisfaction.Results There was no statistical difference between the two groups in general conditions,APAIS before examination,propofol dosage,examination time,NRS scores,physician and patient satisfactions(P>0.05).The AP group presented remarkably shorter awaking time and discharge time than the FP group(P<0.05).Both groups showed decreases in MoCA scores before discharge,compared with those before examination(P<0.05),where the MoCA score of the AP group was higher than that of the FP group(P<0.05).There was no statistical difference in MoCA score between the two groups at other time points(P>0.05).The incidence of postoperative nausea,vomiting and apnea in the AP group was significantly lower than

关 键 词：阿芬太尼 芬太尼 丙泊酚 靶控输注 老年人 术后认知功能 无痛结肠镜检查术 

分 类 号：R614[医药卫生—麻醉学]