70岁以上老年患者静脉麻醉下胃肠镜检查的安全性

Gastrointestinal endoscopy in elderly patients over 70 with conscious anesthesia

目的评价芬太尼和异丙酚静脉麻醉在≥70岁老年患者胃肠镜检查中的安全性。方法回顾分析826例采用静脉麻醉下胃肠镜检查且年龄≥70岁老年患者的临床资料，按年龄分成2组：A组，70～80岁，618例，其中接受胃镜检查者342例，肠镜检查者276例；13组，〉80岁，208例，其中接受胃镜检查者112例，肠镜检查者96例。另随机抽取同期接受静脉麻醉下胃肠镜检查的年龄〈70岁的患者600例（胃镜检查者400例，肠镜检查者200例）作对照。总结分析胃肠镜检查情况，比较相同检查方式下各组血压、心率、血氧饱和度（SpO2）变化情况以及不良反应发生情况。结果所有接受静脉麻醉患者均未发生胃肠镜检查穿孔及死亡等严重事件，亦无一例因麻醉并发症终止胃肠镜检查，均能达到胃肠镜检查的满意镇静程度。对应检查方式下，随年龄增加异丙酚用量均减小：胃镜检查时，异丙酚平均剂量A组为（54．22±21．36）mg，B组为（40．22±12．46）mg，对照组为（86．44±34．26）mg；肠镜检查时，A组为（82．56±40．64）mg，B组为（45．36±15．44）mg，对照组为（102．23±46．32）mg。相同检查方式下各组心率、血压变化程度不大，组内前后两观察时点比较差异均无统计学意义（P〉0．05）；但静脉麻醉对老年患者SpO2影响较大，A组和B组共18例出现SpO2〈90％，主要为唾液误吸入气管引起呛咳所致，予面罩呼吸气囊加压吸氧后短期内恢复。结论在严格控制适应证的条件下，适当剂量麻醉药静脉麻醉下老年患者胃肠镜检查是安全的、可行的。

Objective To evaluate the safety of conscious venous anesthesia with fentanyl and propofol in elderly patients over 70 during gastrointestinal endoscopy. Methods Clinical data of 826 elderly patients over 70, who underwent gastrointestinal endoscopy with venous anesthesia, were retrospectively analyzed. The patients were divided into 2 groups according to their ages, with 618 patients aging from 70 to 80 in group A, in which 342 received endoscopy and 276 underwent colonoscopy, and 208 patients older than 80 in group B, in which 112 underwent endoscopy and 96 had colonoscopy. Another cohort of 600 patients younger than 70, who underwent venous anesthetic endoscopy during the same time period, was randomly selected as the control group, in which 400 patients received endoscopy and 200 had colonoscopy. Blood pressure, heart rate, peripheral oxygen saturation （SpO2 ） and adverse reaction were monitored in each patient during the procedure and compared among different groups. Results No procedure-related perforation or sedation-related mortality was observed, and no procedure was terminated due to sedation complication. The average dosages of propofol used in procedure of endoscopy in groups A, B and control were 54. 22 ±21.36 mg, 40. 22 ± 12. 46 mg, and 86. 44 ±34. 26 mg, respectively. The average dosages of propofol in colonoscopy were 82. 56 ±40. 64 nag, 45.36 ± 15.44 mg and 102.23 ±46. 32 mg, respectively. With same procedure, there was no significant difference in heart rate and blood pressure among different groups, nor was there any difference in these variables before and after the procedure in each group （ P 〉 0. 05 ）. Sedation exerted more influence on SpO2 in elderly patients. A total of 18 cases in groups A and B experienced SpO2 〈90%, which was mainly due to aspiration of saliva and relieved by oxygen inhalation. Conclusion Under appropriate monitor, it is safe and feasible to give conscious sedation to elderly patients over 70 during gastrointestinal endoscopy.