亚催眠剂量丙泊酚复合芬太尼在老年患者胃镜检查中的应用

Application of propofol combined with fentanyl at sub-hypnotic dose for gastroscopy in elderly patients

目的：观察亚催眠剂量丙泊酚复合芬太尼在老年患者胃镜检查中的有效性及安全性。方法：经患者知情同意 选择60名 65～80岁老年患者、ASA I～Ⅲ级，体重、身高均在正常范围。排除标准：无严重心肺疾患、无精神性疾病，男女不限，随机分为2组（n=30）：P组为亚催眠剂量丙泊酚复合芬太尼清醒镇静试验组，C组为丙泊酚复合芬太尼全麻对照组。常规监护患者SPO2、ECG、Bp，并对患者的镇静效果进行评分。结果：共有60例患者完成了该临床观察。P组30例患者都能达到良好的镇静状态完成胃镜检查，并能够维持警觉/镇静（OAA/S）评分3分；相对C组，患者丙泊酚用量及离开医院时间，2组间差异有统计学意义 （P〈0.05）。同时C组患者生命体征相对P组对呼吸、循环抑制更为明显，2组间差异有统计学意义（P〈0.05）。结论：亚催眠剂量丙泊酚复合芬太尼在老年患者胃镜检查中安全有效。

OBJECTVE To investigate the efficacy and safety of propofol combined with fentanyl at sub-hypnotic dose lor gastroscopy in elderly patients. METHODS Sixty elderly patients undergoing gastroscopy were randomly divided into 2 groups： propofol-fentanyl group at sub-hypnotic dose （Group P） and propofol-fentanyl group under general anesthesia （Group C）. Each group included 30 patients. Before gastroscopy, all patients received 1 μg· kg^-1 fentanyl. In Group P, infusion of popofol was started at a loading dose of 0. 4 mg.kg 1 , followed by maintenance dose of 30 μg· kg^-1·h^-1 Meanwhile, SpO2, ECG, Bp and Observer＇s assessment of alertness/sedation（OAA/S） were measured. Patients were undergoing gastroscopy when the scores were reduced to 3. Patients in Group C received 1.5 mg·kg^-1 popofol. RESULTS Sixty 60 patients were e- valuated for enrollment, excluding the patients who underwent more than 10 min for gastroscopy. In Group P, all patients re- ceived operations at a stable sedation state. Moreover, less respiratory depression, less circulatory collapse and less hospitalized days were recorded in Group P （P〈0. 05）. CONCLUSION The sub-hypnotic dose of propofol combined with fentanyl can provide a safe. effective and feasible option for anesthesia in elderly patients.