不同阿片类药物对老年患者无痛肠镜检查延迟性恶心呕吐的影响  

Effects of Different Opioids on Delayed Nausea and Vomiting in Elderly Patients Undergoing Painless Enteroscopy

作　　者：张明月[1] 夏晓琼[1] 余泳波 马贵芬 徐晓梅 杨茗 ZHANG Ming-yue;XIA Xiao-qiong;YU Yong-bo;MA Gui-fen;XU Xiao-mei;YANG Ming(Department of Anesthesiology,Chaohu Hospital of Anhui Medical University,Chaohu 238000,Anhui,China)

机构地区：[1]安徽医科大学附属巢湖医院麻醉科,安徽巢湖238000

出　　处：《医学信息》2024年第10期121-125,共5页Journal of Medical Information

基　　金：安徽医科大学麻醉学与药理学共建项目(编号:2021lcxk040)。

摘　　要：目的观察不同阿片类药物复合依托咪酯-丙泊酚(EP)混合液对老年患者无痛肠镜检查延迟性恶心呕吐的影响。方法选取2022年6月-2023年6月我院行无痛肠镜检查的患者150例。采用随机数字表法分为地佐辛组(D组),瑞芬太尼组(R组),羟考酮组(O组)3组,每组50例。分别静注地佐辛0.04 mg/kg;瑞芬太尼0.4μg/kg;羟考酮0.04 mg/kg,再缓慢静注EP混合液0.15~0.2 ml/kg后行肠镜检查。比较三组患者诱导前(T0),诱导后1 min(T1),肠镜过结肠肝区时(T2),肠镜退出体外时(T3),苏醒后(T4)的MAP、HR、SpO2。肠镜检查时间、苏醒时间及EP混合液总用量,术中、复苏室时不良反应的发生情况。并于术后1、3天回访患者是否出现延迟性恶心呕吐。结果T1时三组MAP、HR、SpO2低于T0时,且R组SpO2下降幅度大于D组和O组(P<0.05);R组术后苏醒时间短于D组和O组,呼吸抑制发生率高于D组和O组(P<0.05);三组肠镜检查时间、使用EP混合液总量、术中体动、肌震颤、头晕、低血压和心动过缓发生率比较,差异无统计学意义(P>0.05);D组和O组术后1天回访恶心呕吐发生率高于在复苏室时,R组在复苏室时和术后1、3天回访恶心呕吐的发生率低于D组和O组(P<0.05)。结论相较于地佐辛与羟考酮,瑞芬太尼复合EP混合液用于老年患者无痛肠镜检查可以使患者苏醒更快,术后更少发生延迟性恶心呕吐,但是可能会引起一过性的呼吸抑制。Objective To observe the effects of different opioids combined with etomidate-propofol(EP)mixture on delayed nausea and vomiting in elderly patients undergoing painless colonoscopy.Methods A total of 150 patients who underwent painless colonoscopy in our hospital from June 2022 to June 2023 were selected.They were randomly divided into dezocine group(group D),remifentanil group(group R)and oxycodone group(group O),with 50 patients in each group.Group D was intravenously injected with dezocine 0.04 mg/kg,group R was intravenously injected with remifentanil 0.4μg/kg,group O was intravenously injected with oxycodone 0.04 mg/kg,and then slowly intravenous injection of EP mixture 0.15-0.2 ml/kg before colonoscopy.The MAP,HR and SpO2 were compared among the three groups before induction(T0),1 min after induction(T1),when the colonoscope passed through the colon liver area(T2),when the colonoscope withdrew from the body(T3),and after recovery(T4).The colonoscopy time,recovery time and total amount of EP mixture,and the occurrence of adverse reactions during operation and resuscitation room were observed.The patients were followed up for 1 and 3 days after surgery to see whether there was delayed nausea and vomiting.Results At T1,MAP,HR and SpO2 in the three groups were lower than those at T0,and the decrease of SpO2 in group R was greater than that in group D and group O(P<0.05).The postoperative recovery time of group R was shorter than that of group D and group O,and the incidence of respiratory depression was higher than that of group D and group O(P<0.05).There was no significant difference in the time of colonoscopy,the total amount of EP mixture,the incidence of intraoperative body movement,muscle tremor,dizziness,hypotension and bradycardia among the three groups(P>0.05).The incidence of nausea and vomiting in group D and group O was higher than that in resuscitation room at 1 day after operation,and the incidence of nausea and vomiting in group R was lower than that in group D and group O at resuscitation room

关 键 词：地佐辛 瑞芬太尼 羟考酮 肠镜 老年 恶心呕吐 

分 类 号：R614[医药卫生—麻醉学]