依托咪酯联合丙泊酚用于老年患者无痛胃肠镜检查的麻醉效果及对患者认知功能的影响

发布时间：2018-07-10 06:51

本文选题：依托咪酯 + 丙泊酚　；参考：《中国药房》2017年15期

【摘要】：目的:探讨依托咪酯联合丙泊酚用于老年患者无痛胃肠镜检查的麻醉效果及对患者认知功能的影响。方法:90例行无痛胃肠镜检查的老年患者随机分为丙泊酚组(30例)、依托咪酯组(30例)和联合组(30例)。丙泊酚组患者给予芬太尼注射液1μg/kg+丙泊酚注射液1.5 mg/kg;依托咪酯组患者给予芬太尼注射液1μg/kg+依托咪酯注射液0.3 mg/kg;联合组患者给予芬太尼注射液1μg/kg+丙泊酚注射液1 mg/kg+依托咪酯注射液0.15 mg/kg。观察3组患者不同时间点的收缩压(SBP)、舒张压(DBP)、心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_2),检查、麻醉诱导、苏醒和定向力恢复时间,神经行为认知状态检查(NCSE)情况,不同时间点的简易精神状态检查表(MMSE)评分及不良反应发生情况。结果:丙泊酚组患者检查时SBP、DBP、MAP、SpO_2均显著低于同组麻醉前、检查后及联合组,差异均有统计学意义(P0.05),但丙泊酚组检查后与同组麻醉前比较,差异均无统计学意义(P0.05)。联合组患者苏醒、定向力恢复时间均显著短于丙泊酚组和依托咪酯组,差异均有统计学意义(P0.05),但依托咪酯组与丙泊酚组间比较,差异均无统计学意义(P0.05)。联合组患者记忆能力、计算能力、定向力检查通过例数占比均显著高于丙泊酚组,差异均有统计学意义(P0.05),但联合组与依托咪酯组、依托咪酯组与丙泊酚组间比较,差异均无统计学意义(P0.05)。联合组患者不同时间点的MMSE评分比较,差异无统计学意义(P0.05);丙泊酚组患者麻醉后15、30 min及依托咪酯组患者麻醉后15 min MMSE评分均显著低于同组麻醉前及联合组,差异均有统计学意义(P0.05),但丙泊酚组麻醉后1 h、依托咪酯组麻醉后30 min及1 h与同组麻醉前比较,差异均无统计学意义(P0.05)。呼吸暂停、低血压、注射痛发生率联合组、依托咪酯组丙泊酚组,体动反应、肌阵挛、恶心呕吐发生率联合组、丙泊酚组依托咪酯组,心动过缓发生率联合组丙泊酚组,差异均有统计学意义(P0.05)。结论:依托咪酯联合丙泊酚用于老年患者无痛胃肠镜检查的麻醉效果较好,可减少检查后认知功能障碍,缩短苏醒时间,且未增加不良反应的发生。
[Abstract]:Objective: to investigate the anesthetic effect of etomidate combined with propofol in painless gastroenteroscopy in elderly patients and its effect on cognitive function. Methods the elderly patients who underwent painless gastroenteroscopy were randomly divided into propofol group (n = 30), etomidate group (n = 30) and combined group (n = 30). Patients in propofol group were given 1 渭 g/kg propofol injection 1.5 mg / kg, etomidate group was given 1 渭 g/kg etomidate injection 0.3 mg / kg, and combination group was given fentanyl injection 1 渭 g/kg propofol injection 1 mg/kg. Etomidate injection 0.15 mg / kg. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), mean arterial pressure (map), blood oxygen saturation (SpO-2), examination, anesthesia induction, recovery time of recovery and orientation, neurobehavioral cognitive state (NCSE) were observed at different time points in the three groups. MMSE scores and adverse reactions at different time points. Results: in the propofol group, the levels of SBPnDBPnMAPSPO2 were significantly lower than those before anesthesia, after examination and in the combined group (P0.05), but there was no significant difference between the propofol group and the same group before anesthesia (P0.05). The recovery time of orientation in combination group was significantly shorter than that in propofol group and etomidate group (P0.05), but there was no significant difference between etomidate group and propofol group (P0.05). The memory ability, computational ability and orientation of patients in the combined group were significantly higher than those in the propofol group (P0.05), but there were significant differences between the combined group and etomidate group, etomidate group and propofol group. The difference was not statistically significant (P0.05). There was no significant difference in MMSE scores at different time points in the combined group (P0.05). The MMSE scores of propofol group and etomidate group were significantly lower than those of the same group and the combined group at 1530 min after anesthesia and 15 min after anesthesia in etomidate group. The differences were statistically significant (P0.05), but the propofol group 1 hour after anesthesia, etomidate group 30 min and 1 hour after anesthesia compared with the same group before anesthesia, the difference was not statistically significant (P0.05). The incidence rate of apnea, hypotension, injection pain, etomidate group, propofol group, body movement reaction, myoclonus, nausea and vomiting incidence rate, etomidate group, bradycardia incidence group, propofol group, etomidate group, propofol group, The difference was statistically significant (P0.05). Conclusion: etomidate combined with propofol is a better anaesthesia for painless gastroenteroscopy in elderly patients, which can reduce cognitive dysfunction, shorten recovery time, and not increase the incidence of adverse reactions.
【作者单位】：贵州省习水县人民医院麻醉科;遵义市第五人民医院;
【基金】：贵州省卫生厅科学技术基金项目(No.gz wkj2013-1-130)
【分类号】：R614

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