亚剂量艾司氯胺酮联合丙泊酚在老年患者无痛胃肠镜检查中的应用  

Low-dose esketamine combined with propofol among elderly patients undergoing painless gastrointestinal endoscopy

作　　者：王蕾[1] 庞申月 杨涛 耿立成[1] WANG Lei;PANG Shenyue;YANG Tao;GENG Licheng(Department of Anesthesiology,Tianjin Union Medical Center,Tianjin 300191,China)

机构地区：[1]天津市人民医院麻醉科,天津300191

出　　处：《空军航空医学》2023年第2期165-169,共5页AVIATION MEDICINE OF AIR FORCE

基　　金：天津市人民医院院级课题基金项目(2022YJ024)。

摘　　要：目的探讨亚剂量艾司氯胺酮联合丙泊酚用于老年患者无痛胃肠镜检查的安全性、有效性以及对术后认知功能的影响。方法选取2021年3月—2022年3月于天津市人民医院行无痛胃肠镜检查的老年患者60例,采用随机数字表法将其分为艾司氯胺酮联合丙泊酚组(EP组)30例和芬太尼联合丙泊酚组(FP组)30例。EP组采用艾司氯胺酮联合丙泊酚进行静脉麻醉;FP组采用芬太尼联合丙泊酚进行静脉麻醉。记录并比较2组丙泊酚使用量、麻醉诱导时间、内镜检查时间、苏醒时间、离室时间、患者及内镜医师满意度、不同时间点生命体征、不良反应发生率、术中镇静、术后疼痛和术后认知功能水平变化等指标。结果与FP组比较,EP组丙泊酚使用量、苏醒时间和离室时间减少,患者及内镜医师的满意度评分升高,差异均有统计学意义(t=9.905、7.761、3.584、6.039、5.125,P<0.001、<0.001、=0.001、<0.001、<0.001)。与FP组比较,EP组术中镇静效果增强,术后疼痛程度减轻,简易智力状态检查量表评分升高,差异均有统计学意义(χ^(2)=6.648、5.455、t=5.334,P=0.010、0.020、<0.001)。在FP组中,与麻醉诱导前即刻(T0)时比较,内镜置入前即刻(T1)、内镜置入后1 min(T2)和操作结束前即刻(T3)时的平均动脉压(mean artery pressure,MAP)、心率(heart rate,HR)和呼吸频率(respiratory rate,RR)均降低,T1和T2时的脉搏血氧饱和度(saturation of pulse oxygen,SpO2)降低,差异均有统计学意义(t=1.785~11.925,P均<0.05);与FP组比较,EP组中T1、T2和T3时的MAP、HR和RR均升高,T1和T2时的SpO2升高,差异均有统计学意义(t=0.183~7.774,P均<0.05)。与FP组比较,EP组严重心动过缓、低血压和低氧血症发生率降低,差异均有统计学意义(P=0.010、0.007、0.028)。结论亚剂量艾司氯胺酮联合丙泊酚麻醉能够安全、有效地应用于老年患者的无痛胃肠镜诊疗,并且能够促进老年患者术后认知功能的早期�Objective To investigate the effects of low-dose esketamine combined with propofol on safety,efficacy and postoperative cognitive dysfunction in elderly patients undergoing painless gastrointestinal endoscopy.Methods Sixty elderly patients who underwent painless gastrointestinal endoscopy in Tianjin Union Medical Center between March 2021 and March 2022 were selected and divided into the esketamine combined with propofol group(group EP,30 cases)and fentanyl combined with propofol group(group FP,30 cases)using the random number table method.Patients in group EP received esketamine combined with propofol for intravenous anesthesia while those in group FP were given fentanyl combined with propofol.Such indexes as the amount of propofol consumption,time of induction,time of endoscopy,time of recovery of consciousness,time patients left the operating room,levels of satisfaction on the part of patients and endoscopists,vital signs,incidence of side effects,intraoperative sedition,postoperative analgesia and cognitive function were compared between the two groups.Results Compared with group FP,patients in group EP consumed less propofol,regained consciousness and left the operating room earlier and were more satisfied with the treatment,and the difference was of statistical significance(t=9.905,7.761,3.584,6.039,5.125,P<0.001,<0.001,=0.001,<0.001,<0.001).Compared with group FP,the effect of intraoperative sedation was enhanced,postoperative pain was mitigated,and the score of mini-mental state examination increased in group EP,with statistically significant difference(χ^(2)=6.648,5.455,t=5.334,P=0.010,0.020,<0.001).In group FP,compared with T0(immediately before anesthesia induction),the mean artery pressure(MAP),heart rate(HR)and respiratory rate(RR)at T1(immediately before endoscopic placement),at T2(1 min after endoscopic placement)and at T3(towards the end of the procedure)decreased,so did the saturation of pulse oxygen(SpO2)at T1 and T2,and the difference was statistically significant(t=1.785-11.925,all P<0.05).Co

关 键 词：麻醉 胃肠镜 艾司氯胺酮 丙泊酚 老年 

分 类 号：R856.74[医药卫生—航空、航天与航海医学]