洛贝林在老年患者内镜手术静脉麻醉中的应用价值

Application value of lobeline in intravenous anesthesia of elderly patients undergoing endoscopic surgery

目的观察洛贝林在老年患者内镜手术静脉麻醉中的应用价值。方法选取2020年2月至2021年2月在孝感市第一人民医院行内镜手术静脉麻醉的300例老年患者,其中150例(对照组)静脉麻醉用药为地佐辛0.05 mg/kg+丙泊酚1.5 mg/kg,余150例(观察组)静脉麻醉用药为地佐辛0.05 mg/kg+洛贝林3.0 mg+丙泊酚1.5 mg/kg。两组患者均将脑电双频指数(bispectral index,BIS)控制在50~60后进行手术操作并维持,术中根据手术进度间断单次追加丙泊酚0.5 mg/kg。观察两组患者麻醉用药开始后1 min(T1)、3 min(T2)、5 min(T3)、10 min(T4)、15 min(T5)各时点的平均动脉压(mean artery pressure,MAP)、心率、脉搏血氧饱和度(pulse oxygen saturation,SpO2)、呼气末二氧化碳分压(end tidal partial pressure of carbon dioxide,PetCO2)、BIS、呼吸暂停和低氧血症发生率,以及患者术后清醒时间、出恢复室时间、苏醒延迟发生率。两组间独立计量资料的比较采用t检验,连续性计量资料的比较采用重复测量方差分析,计数资料的比较采用χ2检验。结果两组患者麻醉用药后SpO2及PetCO2的差异有统计学意义(F=13.620、19.250,P<0.05),其中观察组T1、T2、T3、T4、T5各时点SpO2及PetCO2均明显高于对照组(P<0.05)。两组患者麻醉用药后MAP、心率及BIS的差异无统计学意义(F=3.521、1.521、1.927,P>0.05)。两组患者清醒时间、出恢复室时间、苏醒延迟发生率的差异均无统计学意义(t=0.181、0.082,χ2=0.000,P>0.05);观察组患者呼吸暂停及低氧血症发生率均明显低于对照组,差异有统计学意义(χ2=31.274、33.166,P<0.01)。结论对于老年内镜手术患者,静脉麻醉中预防性使用洛贝林能显著降低老年患者术中低氧血症的发生率,且不延长患者术后的苏醒和出室时间,安全性高。

Objective To observe the application value of lobelin in the elderly patients with endoscopic surgery under intravenous anesthesia.Methods 300 elderly patients who received intravenous anesthesia for endoscopic surgery in Xiaogan First People’s Hospital from February 2020 to February 2021 were selected.Among them,150 cases(control group)were given intravenous anesthesia with dezocine 0.05 mg/kg+propofol 1.5 mg/kg,and the other 150 cases(observation group)were given intravenous anesthesia with dezocine 0.05 mg/kg+lobeline 3.0 mg+propofol 1.5 mg/kg.The bispectral index(BIS)was controlled in 50-60 for operation and maintenance..During the operation,0.5 mg/kg of propofol was added intermittently single time according to the operation progress.The mean arterial pressure(MAP),heart rate,pulse oxygen saturation(SpO2),pulse oxygen saturation(PetCO2),BIS,apnea,hypoxemia,the incidence of postoperative awake time,recovery time and recovery delay rate were observed at 1 min(T1),3 min(T2),5 min(T3),10 min(T4),and 15 min(T5)after starting anesthesia in two groups.T test was used to compare the independent measurement data between the two groups,repeated measurement analysis of variance was used to compare the continuous measurement data,andχ2 test was used to compare the counting data.Results There were significant differences in SpO2 and PetCO2 between the two groups after anesthesia(F=13.620,19.250,P<0.05),and the SpO2 and PetCO2 in the observation group were significantly higher than those in the control group at T1,T2,T3,T4 and T5(P<0.05).There was no significant difference in MAP,heart rate and BIS between the two groups(F=3.521,1.521,P<0.05).There were no significant difference in awake time,time out of recovery room and incidence of delayed recovery between the two groups(t=0.181,0.082,χ2=0.000,P>0.05),the incidence of apnea and hypoxemia in the observation group was significantly lower than that in the control group,the difference was statistically significant(χ2=31.274,33.166,P>0.05).Conclusion For elderly patients with endoscopic surgery,the prophylactic use of lobeline in intravenous anesthesia is safe and effective,which can significantly reduce the incidence of hypoxemia in elderly patients,and does not prolong the postoperative recovery and out of room time.