氢吗啡酮复合丙泊酚用于老年患者无痛胃镜联合结肠镜检查术的疗效及安全性

Efficacy and safety of hydromorphone combined with propofol in painless gastroscopy-colonoscopy combined examination in elderly patients

目的 评价氢吗啡酮复合丙泊酚静脉全麻用于老年患者无痛胃镜联合结肠镜检查术的临床疗效及安全性.方法 选取择期行无痛胃镜联合结肠镜检查术的老年患者61例,年龄60～75岁,采用随机数字表法将所有患者随机均分为两组：H组（n=31）患者静脉注射氢吗啡酮30μg/kg,10 min后给予丙泊酚负荷剂量1.0 mg/kg,静注时间60s,丙泊酚维持量8 mg·kg^-1·h^-1;P组（n=30）患者静脉注射等容量生理盐水,10 min后给予丙泊酚,其用法用量同H组.待患者睫毛反射消失后即行胃镜及结肠镜检查术.记录两组患者麻醉前5 min （T0）、睫毛反射消失时（T1）、检查开始后10 min （T2）、20min （T3）、30min （T4）、术毕时（T5）、术毕后5min （T6）及术毕后10min （T7）时平均动脉压（MAP）、心率（HR）、呼吸频率（RR）及脉搏血氧饱和度（SpO2）;记录两组患者术中及术毕清醒后5、15、30、45、60 min时视觉模拟评分（VAS）和Ramsay镇静评分.记录两组患者术毕清醒后60 min内的不良反应发生率.结果 与P组比较,H组患者T2～T4时的MAP、T1～T7时的HR均降低（P＜0.05）,而T1时的RR、T1～T7时的SpO2均升高（P＜0.05）.与P组比较,H组患者术毕5～30 min时的VAS评分、术毕5～ 60 min时的Ramsay镇静评分均降低（P＜0.05）.与P组比较,H组患者麻醉苏醒时间、丙泊酚用量均减少（P＜0.05）.与P组比较,H组患者术中高血压（16.1％ vs.46.7％）、窦性心动过速（16.1％ vs.43.3％）、呛咳（12.9％ vs.36.7％）、体动反应（9.7％vs.46.7％）、呃逆（6.5％vs.36.7％）及注射痛（25.8％ vs.93.3％）等发生率均降低（P＜0.05）,而术毕清醒后60 min内的恶心发生率（19.4％ vs.0）升高（P＜0.05）,躁动不安发生率（6.7％vs.30.0％）则降低（P＜0.05）.结论 氢吗啡酮复合丙泊酚静脉全麻用于老年患者无痛胃镜联合结肠镜检查术的镇痛效果较好,且不良反应发生率更低,可安全应于临床.

Objective To explore the clinical efficacy and safety of hydromorphone combined with propofol in painless gastroscopy-colonoscopy combined examination in elderly patients.Methods 61 patients aged 60-75 years old undergoing painless gastroscopy-colonoscopy combined examination,were randomly divided into two groups as follows：patients of group H （n=31） were injected intravenously with hydromorphone at a dose of 301μg/kg,and after 10 min propofol was injected intravenously at a loading dose of 1.0 mg/kg,and time of intravenous injection for 60 s,following continuous intravenously pumped at a rate of 8 mg·kg1·h1;patients of group P （n=30） were given isovolumetric normal saline,and after 10 min intravenously injected with propofol whose usage and dosage were the same as group H.After eyelash reflex of patients disappeared,painless gastroscopy-colonoscopy combined examination was performed.Mean artery blood pressure （MAP）,heart rate （HR）,respiratory rate （RR）,and oxygen saturation （SPO2） of patients were recorded respectively at 5 min before anesthesia （T0）,the onset of eyelash reflex disappeared （T1）,10,20,30 min after examination （T2-4）,the end of examination （T5）,5 and 10 min after examination （T6-7）.Visual analogue scale （VAS） and Ramsay sedation score of patients were recorded at 5,15,30,45,60 min after anesthetic recovery in two groups.Adverse reactions during examination and within 60 min after examination were analyzed.Results Compared with group P,MAP at T1-T4 and HR at T1-T7 in group H were all lower （P〈0.05）,and RR at T1 and SPO2 at T1-T7 were all higher （P〈0.05）.Compared to group P,VAS at 5-30 min after anesthetic recovery and Ramsay sedation score at 5-60 min after anesthetic recovery in group H were all lower （P〈0.05）.Compared to group P,anesthetic revival time and consumption of propofol in group H were both lower （P〈0.05）.Compared with group P,the incidence of intraoperative hypertension,sinus tachycardia,bucking,restless moving,hiccups,and injection pain in group H were all lower （16.1% vs.46.7%,16.1%vs.43.3%,12.9% vs.36.7%,9.7% vs.46.7%,6.5% vs.36.7%,25.8% vs.93.3%;P〈0.05）,while the incidence of nausea was higher within 60 min after anesthetic recovery （19.4% vs.0%,P〈0.05）,and the incidence of restlessness was lower （6.7% vs.30.0%,P〈0.05）.Conclusion The analgesic effect of hydromorphone combined with propofol in painless gastroscopy-colonoscopy combined examination is favorable for elderly patients,with less adverse reactions and higher security.