不同剂量阿芬太尼复合丙泊酚在老年患者无痛结肠镜检查中的麻醉效果及对术后疲劳综合征影响的比较研究  

Comparison of the anesthetic effect of different doses of alfentanl complex propofol in painless colonoscopy in elderly patients and the effects of postoperative fatigue syndrome

作　　者：沈卓尔 徐海 朱婷婷 周红梅 SHEN Zhuoer;XU Hai;ZHU Tingting;ZHOU Hongmei(Department of Anesthesiology,the Second Hospital of Jiaxing,Jiaxing 314000,Zhejiang,China)

机构地区：[1]嘉兴市第二医院麻醉科,浙江嘉兴314000

出　　处：《中国现代医生》2024年第17期70-75,共6页China Modern Doctor

基　　金：浙江省嘉兴市科技计划项目(2022AD30027)。

摘　　要：目的不同剂量阿芬太尼复合丙泊酚在老年患者无痛结肠镜检查中的麻醉效果及对术后疲劳综合征的影响。方法选取2022年1月至3月在笔者医院门诊内镜中心行择期无痛结肠镜检查的患者120例,年龄65~80岁,性别不限,体质量指数(body massindex,BMI)18~28 kg/m^(2),美国麻醉医生协会(American Society ofAnesthesiologist,ASA)分级Ⅰ~Ⅱ级。采用随机数字表法分将患者分别纳入三组:阿芬太尼5μg/kg组(N_(1)组)、阿芬太尼7.5μg/kg组(N_(2)组)、阿芬太尼10μg/kg组(N_(3)组),每组40例。记录麻醉前(T_(1))、麻醉诱导后(T_(2))、开始置入结肠镜(T_(3))、肠镜到达回盲部(T_(4))、检查结束时(T_(5))时的心率、平均动脉压、血氧饱和度;记录三组患者麻醉镇静成功率、丙泊酚用量情况、镇静诱导时间、肠镜检查时间、镇静苏醒时间、血管活性药物使用情况及医生满意度;记录三组患者术中低氧血症发生率、低血压、心动过缓、不自主体动和术后恶心、头晕发生率及术后疲劳综合征(postoperative fatiguesyndrome,POFS)等不良反应的发生情况。结果与T_(1)时比较,T_(2)~T_(5)三组患者平均动脉压均明显降低(P<0.05),N_(1)组T_(3)时心率明显升高(P<0.05);与N_(1)组比较,N_(2)组和N_(3)组丙泊酚总用量、补救镇静次数、诱导时间、苏醒时间及血管活性药物使用情况均降低,麻醉镇静成功率显著升高(P<0.05)。N_(2)组比较,N_(1)组和N_(3)组医生满意度降低(P<0.05)。与N_(1)组比较,N_(2)与N_(3)组术中低血压发生率及术后POFS发生率降低(P<0.05);与N_(3)组比较,N_(1)与N_(2)组术中低氧血症发生率降低(P<0.05)。结论阿芬太尼7.5µg/kg复合丙泊酚能够安全有效地应用于老年患者无痛结肠镜检查,并且不良反应发生率较低,提高患者术后恢复质量,值得临床推广应用。Objective To explore the clinical effect of different doses of alfentanil combined with low-dose propofol in painless colonoscopy in elderly patients.Methods A total of 120 elderly patients undergoing elective painless colonoscopy from January to March 2022,aged 65 to 80 years,gender unlimited,body mass index(BMI)18-28kg/m^(2),American Society of Anesthesiologists(ASA)gradeⅠ-Ⅱ.Patients were included in the three groups by random number tables:alfentanyl 5μg/kg(N_(1)),alfentanyl 7.5μg/kg(N_(2)),and alfentanyl 10μg/kg(N_(3)),40 patients in each group.Record the heart rate,mean arterial pressure,and oxygen saturation were recorded before anesthesia(T_(1)),after anesthesia induction(T_(2)),colonoscopy(T_(3)),colonoscopy reaching the ileocecum(T_(4)),and at the end of examination(T_(5)).The success rate of anesthesia sedation,dosage of propofol,sedative induction time,colonoscopy time,sedative recovery time,use of vasoactive drugs and physician satisfaction of the three groups were recorded.The incidence of intraoperative hypoxemia,hypotension,spontaneous ycardia,bradycardia,postoperative nausea and dizziness,and postoperative fatiguesyndrome(POFS)and the occurrence of adverse reactions.Results Compared with T_(1),the mean arterial pressure in T_(2)-T_(5) patients decreased significantly(P<0.05),and the heart rate at T_(3) increased significantly(P<0.05)in N_(1),the total dosage,induction time,induction time,awakening time and vasoactive drug use were decreased in N_(2) and N_(3),and the success rate of anesthesia sedation was significantly increased(P<0.05).Comparing the N_(2) group,physician satisfaction decreased in the N_(1) and N_(3) groups(P<0.05).The incidence of intraoperative hypotension and postoperative POFS decreased in the N_(2) and N_(3) groups(P<0.05)and in the N_(1) and N_(2) groups(P<0.05).Conclusion Afunentanil 7.5µg/kg compound propofol can be used safely and effectively for painless colonoscopy in elderly patients,and the incidence of adverse reactions is low,which improves the quality of p

关 键 词：阿芬太尼 丙泊酚 老年 无痛肠镜 

分 类 号：R614[医药卫生—麻醉学]