丙泊酚联合地佐辛对老年无痛肠镜应激指标的影响

Effects of Propofol Combined with Dezocine on Stress Index in Elderly Patients with Painless Colonoscopy

目的研究丙泊酚联合地佐辛对老年无痛肠镜应激指标的影响。方法选取2014年3月至2015年4月收入无锡市锡山人民医院行无痛肠镜的老年患者220例为研究对象。按随机数字表法分为观察组和对照组,各110例。观察组使用地佐辛和丙泊酚联合麻醉(先静脉缓慢注射5 mg地佐辛,10 min后,静脉注射2.0 mg/kg丙泊酚),对照组仅使用丙泊酚麻醉(静脉注射2.0 mg/kg丙泊酚),并对两组收缩压、舒张压、心率及脉搏血氧饱和度(SpO_2),丙泊酚用量、苏醒时间及视觉模拟评分(VAS),不良反应及应激指标进行比较。结果术中,两组生命体征平稳,未出现麻药物过敏现象。术中,观察组收缩压、舒张压、心率均较对照组显著降低[(105.69±8.77)mmHg(1 mmH g=0.133 k Pa)比(122.14±9.46)mmHg、(62.34±6.76)mmHg比(78.01±9.41)mmHg、(71.30±6.44)次/min比(80.58±10.32)次/min],SpO_2较对照组显著增加[(0.986±0.011)比(0.947±0.010)],差异有统计学意义(P<0.05)。观察组术中丙泊酚用量显著低于对照组[(82±8)mg比(123±19)mg],差异有统计学意义(P<0.05)。术后,两组苏醒时间差异无统计学意义(P>0.05)。与对照组相比,观察组术后不良反应较少,仅3例出现恶心呕吐,对照组不良反应种类及例数较多,观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。两组术中、术后皮质醇和血管紧张素Ⅱ水平均呈先升高后降低趋势,观察组变化幅度更小,两组在组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。结论丙泊酚联合地佐辛用于对老年无痛肠镜检查和治疗中,具有治疗方便,安全性好,应激反应小的特点,值得临床推广应用。

Objective To investigate the effects of propofol combined with dezoeine for stress index and prognosis in elderly patients with painless colonoscopy. Methods Total of 220 elderly patients in Xishan People＇s Hospital from Mar. 2014 to Apr. 2015 were divided into an observation group and a control group according to the random number table method, 110 patients each. The observation group was given dezocine and propofol combined anesthesia （5 mg intravenous dezocine, 2. 0 mg/kg intravenous propofol after 10 rain）, the control group received only propofol anesthesia（2.0 mg/kg intravenous propofol）, and the systolic pressure（SBP） ,diastolic pressure （SBP） ,heart rate（HR） and blood oxygen saturation（ SpO2 ） ,propo fol dosage, recovery time and visual analogue scale/score （ VAS scores）, adverse reactions and the stress index of the two groups were compared. Results During the operation, the vital signs of the two groups were stable, and there was no allergic phenomenon. During the operation, SBP, SBP, HR and SpO2 of the observa- tion group were all decreased than the control group[ （ 105.69 ± 8.77 ） mmHg vs （ 122.14 ± 9.46 ） mmHg, （62.34 ±6.76） mmHg vs （78.01 ±9.41） mmHg, （71.30 ± 6.44） times/min vs （80.58 ± 10.32） times/mini ,SpO2 were significantly increased[ （0. 986 ±0. 011 ） vs （0. 947 ±0. 010） ] ,the difference was statistically significant（ P 〈 0.05 ）. The average dosage of propofol in the observation group was significantly lower than the control group [ （82 ± 8 ）mg vs （123 ± 19 ）mg ] （P 〈 0.05 ）. The postoperative wakening time of the two groups was not statistically significant（P 〉0.05 ）. Compared with the control group, the obse4va- tion group had less adverse reactions, and only 3 patients had vomiting. The number of adverse reactions in the control group was more, and the difference between the two groups was statistically significant （ P 〈 0.05）. The serum evels ofcqrtisol and angiotensin of both groups were firstly increased and then decreased during and after operation,the observation group was less changed,the differences between groups, different time points, and the interaction of groups time points were statistically significant （ P 〈 0. 05 ）. Conclusion Propofol combined with dezocine for elderly patients undergoing painless colonoscopy exam nation and treatment, has the advantages of convenient treatment, good safety, and less stress response, thus is worthy of clinical application.