丙泊酚伍用氯胺酮在老年人胃镜检查术上的效果

Propofol with ketamine on old patients gastroscopy

目的：比较丙泊酚伍用不同剂量氯胺酮或伍用芬太尼在老年人胃镜检查术上的效果,寻找老年人无痛胃镜的适宜方法。方法：90例拟行无痛胃镜的老年病人,年龄60-80岁,ASAⅠ-Ⅲ级,随机分为三组,每组30例。A组先静注丙泊酚1.5 mg·kg^-1后,马上静注氯胺酮0.1 mg·kg^-1;B组先静注丙泊酚1.5 mg·kg^-1后,马上静注氯胺酮0.2 mg·kg^-1;C组先静注芬太尼0.8μg·kg^-1,马上静注丙泊酚1.5 mg·kg^-1。有明显肢动时追加丙泊酚0.5 mg·kg^-1。记录病人推药前、推药即刻、2、5、10分后的心率、血压、氧饱和度;分别于麻醉前和苏醒后10分钟、苏醒后30分钟用简易精神状态量表（MMSE）测试认知功能;并观察术中肢动、苏醒时间、术后眩晕、呕吐发生情况。结果：和丙泊酚伍用芬太尼（A组）相比较,丙泊酚伍用氯胺酮0.2mg·kg^-1（B组）镇痛效果相同,都比较满意,但是血压、氧饱和度无明显下降。结论：丙泊酚1.5 mg·kg^-1伍用氯胺酮0.2 mg·kg^-1对于不能耐受呼吸、循环抑制且需要足够镇痛强度的老年患者可以选用。

Objective： Comparison of the analgesic effect of propofol combined with different doses of ketamine, or combined with fentanyl on old patients undergoing gastroscopy. Methods.. Ninety old patients （aged 60-80 years, ASA Ⅰ-Ⅲ ）, who underwent gastroscopy, were randomly divided into three groups. In Group A, patients were administrated intravenously with propofol, at 1.5 mg· kg^-1, and immediately with ketamine, at 0.1 mg · kg^-1 ; In group B, patients were administrated intravenously with propofol, at 1.5 mg· kg^-1 , and immediately with ketarnine, at 0.2 mg · kg^-1; In group C patients were administrated intravenously with fentanyl, at 0.8μg · kg^-1, and immediately with propofol, at 1.5 mg · kg^-1. Additional propofol 0.5 mg · kg^-1 was added while the patient moved. HR, BP and .Sp O2 were recorded at before, and 0,2,5,10 minutes, respectively, after the drugs injection. The cognitive function was tested by MMSE scale before anesthesia, and at 10 min, 30 min after patient awareness, respectively,. The amount of limb motion during gastroscopy, the time point when patient being awareness, or nausea and vomiting, vertigo and dizziness after gastroscopy were also recorded, respectively. Results： The analgesic effect of propofol （1.5 mg · kg^-1 ） with ketamine （0.2 mg · kg^-1） on old patients undergoing gastroscopy was satisfactory and similar to that of propofol（1.5 mg · kg^-1 ） with fentanyl （0.8μg ·kg^-1）, however, HR, BP and Sp O2 in group of propofol（1.5 mg · kg^-1） with ketamine （0. 2 mg · kg^-1） did not decrease significantly, compared with group of propofol（1.5 mg · kg^-1 ） with fentanyl （0.8μg · kg^-1 ）. Conclusion：Combined propofol （1.5 mg · kg^-1） with ketarnine （0. 2 mg · kg^-1） is a suitable choice for old patients undergoing gastroscopy, who need enough analgesia and could not tolerate with respiratory and circulatory depression.