不同药物静脉麻醉用于老年患者胃镜检查的分析

Comparison of different drugs in intravenous anesthesia for aged people’s painless gastroscopy

目的评价不同药物静脉麻醉用于老年患者胃镜检查的效应及安全性。方法回顾分析620例采用静脉麻醉下胃镜检查且年龄≥65岁老年患者的临床资料,按麻醉用药不同分为4组:P组,单纯丙泊酚组;FP组,芬太尼复合丙泊酚组;RP组,瑞芬太尼复合丙泊酚组;MP组,咪唑安定复合丙泊酚组。分析各组丙泊酚用量、苏醒时间,术中患者MAP、HR、SPO2变化及不良反应发生情况。结果所有麻醉均达到满意镇静程度;丙泊酚用量P组(90.46±28.28)mg明显高于其他3组([65.42±20.10)、(61.38±19.84)和(62.02±21.34)mg](P<0.05);苏醒时间P组(9.02±2.62)min、MP组(8.32±1.62)min明显长于FP组(6.10±1.82)min和RP组(6.02±1.71)min(P<0.05);麻醉后患者MAP、HR、SPO2均一过性下降,其中SPO2<90%的发生率,P组(10.6%)、MP组(11.9%)多于FP组(0%)和RP组(0%)(P<0.05)。结论丙泊酚单独应用或者伍用芬太尼、瑞芬太尼、咪唑安定等均可用于老年患者胃镜检查,其中以伍用芬太尼或瑞芬太尼较为理想。

[Objective]To investigate the effect and security of different drugs in aged people’s painless gastroscopy. [Methods]620 patients aged ≥65 years undergoing painless gastroscopy were analyzed retrospectively. The patients were divided into four groups as group P （intravenous injection with propofol）, group FP （intravenous injection with fentanyl and propofol）, group RP （intravenous injection with remifentanil and propofol）and group MP （intravenous injection with midazolam and propofol）. The changes of MAP, HR, SPO2, total dosage of propofol, recovery time and side effect were analyzed. [Results]All patients received satisfactory sedation. The total dosage of propofol in group P （90.46±28.28） mg was significantly larger than those in other groups （65.42±20.10） mg, （61.38± 19.84） mg, （62.02±21.34） mg （P〈0.05）, The recovery time in group P （9.02±2.62） min and group MP （8.32±1.62） min were longer than that in group FP （6.10±1.82） min and group RP （6.02±1.71） min. The MAP、HR and SpO2 were declined after anesthesia in four groups, the incidences of SPO2 90% in group P （10.6% ）and group MP （11.9%） were obviously higher than that in group FP （0%） and group RP （0%）. [Conclusion]Propofol with or without fentanyl, remifantanil, midazolam can be used in aged people’s painless gastroscopy, and remifantanil or fentanyl combined with propofol is superior to others.