体能评估对行无痛胃镜检查的老年患者血流动力学变化的预测与干预

Predictive value of physical performance assessment for hemodynamic changes in elderly patients undergoing painless gastroscopy

目的探讨体能评估对老年患者行无痛胃镜检查中血流动力学变化的预测意义。方法选取行无痛胃镜检查的200例老年患者,ASA ( American Society of Anesthesiologist, ASA)分级Ⅰ~Ⅲ级,由不知道分组的麻醉医生在检查前使用Duke活动指数对其检查前14 ~20 d期间的日常体能状况进行评估,随机分成低体能组(Ⅰ组)、体能中等组(Ⅱ组)、体能良好组(Ⅲ组),面罩吸氧3 min后静脉注射丙泊酚2.0 mg/kg,观察检查中患者诱导前(T1)、用药后1 min(T2)、进镜时(T3)、进镜后3 min(T4)、退镜时(T5)、退镜后5 min(T6)、苏醒时(T7)的血压(BP)、心率(HR)、脉搏血氧饱和度(SpO2)的变化,记录3组患者不良反应情况。结果每组各时点与T1相比,T2-T7的HR、舒张压(SBP)、收缩压(DBP)、平均动脉压(MAP)均出现下降(P<0.05)。3组间比较,HR、SpO2无明显差异,Ⅰ组在T1、T4、T6时点的MAP低于Ⅱ、Ⅲ组(p<0.05)。 3组间比较,I组血压抑制、Ⅲ组体动的发生率高(P<0.05)。结论无痛胃镜检查前对患者进行体能评估可以预测检查中血流动力学变化、不良反应的发生情况,为丙泊酚用量及应用血管活性药物等干预措施提供依据。

Objective To investigate the predictive value of physical performance assessment for hemodynamic changes in elderly patients undergoing painless gastroscopy. Methods A total of 200 elderly patients, ASA gradeⅠ-Ⅲ, undergoing painless gastroscopy were enrolled in this study. Their daily physical conditions 14-20 days before ex amination were evaluated using the Duke activity index. The patients were randomly divided into a low energy group (GroupⅠ), a moderate energy group ( Group Ⅱ), and a good energy group ( Group Ⅲ). The patients were intrave nously injected with 2.0 mg/kg propofol 3 min after oxygen inhalation. Then, the changes in HR, SBP, DBP and MAP before anesthesia induction (T1 ), 1 min after treatment (T2 ), during insertion (T3 ), 3 min after insertion (T4 ), dur ing removal (T5 ), 5 min after retraction (T6 ), and after recovery (T7). Adverse reactions in the three groups were also recorded. Results Each groups presented decreases in HR, SBP, DBP and MAP at T2 -T7 , compared with those at T1(P < 0.05 ). There was no significant difference in HR and SpO2 among the three groups. MAP in Group I was lower than those in Groups Ⅱ and Ⅲ at Tv2 , T4 and T6 ( P < 0.05 ). Furthermore, the incidence of inhibited blood pressure in Group I was higher than that in Group Ⅲ(P < 0. 05 ). Conclusions Physical assessment of patients before painless gastroscopy can predict the changes of hemodynamics and the occurrence of adverse reactions in the examination, and provide evidence for propofol dosage and vasoactive agents.