BIS监测下右美托咪啶复合丙泊酚和芬太尼用于老年无痛肠镜的麻醉观察

The effects of dexmedetomidine combined with propofol and fentanyl on painless colonoscopy in older patients in BIS monitored

目的观察BIS监测下右美托咪啶复合丙泊酚和芬太尼在老年患者无痛肠镜中的麻醉效果。方法选取60例肠镜检查的老年患者,采用随机数字法分为右美托咪啶复合丙泊酚和芬太尼麻醉组(观察组)和单纯丙泊酚加芬太尼麻醉组(对照组),观察记录两组患者不同时间点的心率、平均动脉压,并比较两组患者术后认知功能情况、苏醒时间和丙泊酚总用量以及不良反应发生率。结果观察组和对照组患者在T1和T2时心率(68.1±7.4,72.2±6.9和69.6±7.8,74.3±6.3)和平均动脉压(79.6±7.2,84.1±7.3和77.6±9.8,82.6±8.9)较T0(82.9±7.1,93.3±5.1和83.7±6.6,95.0±6.8)均下降(P<0.01);与对照组相比,观察组患者在T1和T2时心率(68.1±7.4,69.6±7.8)和平均动脉压(79.6±7.2,77.6±9.8)下降幅度大于同时期的对照组(72.2±6.9,74.3±6.3和84.1±7.3,82.6±8.9)(P<0.05或P<0.01)。对照组患者检查后MMSE评分(24.6±4.9)较检查前(28.3±6.1)降低,定向力评分(246±37)较检查前(224±29)升高(P<0.05),观察组患者检查后MMSE评分(27.3±5.3)高于对照组(24.6±4.9),定向力评分(227±31)低于对照组(246±37)(P<0.05);观察组患者苏醒时间(11.5±4.1)和丙泊酚用量(164.0±33.4)低于对照组(14.2±5.9,207.5±40.9)(P<0.05或P<0.01);观察组患者术中体动反应(16.7%)和术中呛咳(10%)的发生率低于对照组(40%,33.3%)(P<0.05)。结论右美托咪啶复合丙泊酚和芬太尼用于老年患者无痛肠镜检查,可以缩短苏醒时间、减少丙泊酚的用量,但对术后认知功能障碍的影响尚不明确。

Objectives To observe the effects of dexmedetomidine combined with propofol and fentanyl on painless colonoscopy in older patients in BIS monitored. Methods 60 colonoscopy patients were randomly divided into the dexmedetomidine combined with propofol and fentanyl anesthesia group（ observation group） and propofol and fentanyl anesthesia group（ control group）,n =30. Heart rate,mean arterial pressure at different time points were recorded,postoperative cognitive dysfunction（ POCD）,recovery time,the total amount of propofol and incidence of adverse reactions in two groups were compared. Results Compared with T0（82.9 ± 7.1,93.3 ± 5.1 and 83.7 ± 6.6,95.0 ± 6.8）,Heart rate（ 68.1 ± 7.4,72.2 ± 6.9 and 69.6 ± 7.8,74.3 ± 6.3） and mean arterial pressure（ 79.6 ± 7.2,84.1 ± 7.3 and 77.6 ± 9.8,82.6 ± 8.9） in T1 and T2 was decreased in both groups（ P〈0.01）,heart rate（ 68. 1 ± 7. 4,69. 6 ± 7. 8） and mean arterial pressure（ 79.6 ± 7.2,77. 6 ± 9.8） in observation group at T1 and T2 were decreased more than the same period in control group（ 72.2 ± 6.9,74.3 ± 6.3 and 84.1 ± 7.3,82.6 ± 8. 9）（ P〈0.05）;the mini-mental state examination（ MMSE） score（ 24.6 ± 4.9） after examination was lower than that before examination（ 28.3 ±6.1） and orientation index（ 246 ± 37） after examination was higher than that before examination（ 224 ± 29） in control group（ P〈0.05）; The MMSE score（ 27.3 ± 5.3） was higher and orientation index（ 227 ± 31） was lower in observation group than that in control group（ 24. 6 ± 4.9,227 ± 31）（ P〈0.05）. The recovery time（ 11.5 ± 4.1） and the total amount of propofol（ 164.0 ±33.4） in observer group was less than control group（ 14.2 ± 5.9,207.5 ± 40.9）（ P〈0.05 or P〈0.01）; the incidence of body movement response（ 16.7%） and cough（ 10%） in observation group was less than that in control group（ 40%,33.3%）（ P〈0.05）. Conclusions Dexmedetomidine combined with propofol and fentanyl on painless colonoscopy in older patients can shorten recovery time and reduce the amount of propofol,but its effect on POCD is unclear.