异丙酚和依托咪酯复合瑞芬太尼对老年食管白斑胃镜下治疗患者呼吸功能及应激的影响分析

Effect of anesthesia with propofol plus remifentanil vs etomidate plus remifentanil on respiratory function and stress in elderly patients with esophageal leukoplakia treated by gastroscopy

背景随着社会发展和科技进步,患者对胃镜的舒适度要求不断提高,且更加关注其可能造成的不良反应,越来越多的患者要求行无痛胃镜的检查和治疗.老年患者由于年龄增长及机体退行性改变,出现血管耐受性、重要脏器功能下降,对麻醉药物的要求更高,因此选择正确的麻醉药物十分重要.目的对比观察异丙酚和依托咪酯复合瑞芬太尼对老年食管白斑胃镜下治疗患者呼吸功能及应激的影响.方法选取2018-04/2018-10间在天津市宁河区医院内镜中心行无痛胃镜下治疗的200例老年食管白斑患者,年龄为62-73岁,采用随机数表法分为对照组和研究组,每组100例患者,对照组采用异丙酚复合瑞芬太尼麻醉,研究组采用依托咪酯复合瑞芬太尼麻醉.对比两组患者治疗前、治疗结束时血清中血氧饱和度(oxygen saturation, SPO2)、应激激素(促肾上腺皮质激素、糖皮质激素、血管紧张素),治疗时血流动力学,治疗时不良反应及停止麻醉后恢复自主呼吸时间的差异.结果治疗前两组血清中应激激素水平基本一致,治疗结束时研究组患者血清中应激激素(促肾上腺皮质激素、糖皮质激素、血管紧张素)的水平明显低于对照组(P <0.05);研究组术中血流动力学更加稳定(P <0.05);研究组术中SPO2也明显高于对照组(P <0.05);出现不良反应的次数也明显减少(P <0.05);但对照组恢复自主呼吸时间明显短于研究组(P <0.05).结论依托咪酯复合瑞芬太尼麻醉较异丙酚复合瑞芬太尼麻醉在老年食管白斑患者行胃镜治疗中炎症因子、应激激素减少,血流动力学更加稳定,且术中SPO2维持好,不良反应发生少,可以在老年食管白斑患行胃镜治疗中推荐使用,但异丙酚复合瑞芬太尼麻醉术后恢复自主呼吸较快.

BACKGROUND With the development of society and the advancement of science and technology, the patient’s requirements for comfort during gastroscopy are constantly increasing, and more attention has been paid to the possible adverse reactions. More and more patients choose to undergo painless gastroscopy. Elderly patients have vascular tolerance, significant organ function decline, and higher requirements for anesthetic drugs due to age and degenerative changes. Therefore, it is important to choose the correct anesthetic drugs during gastroscopy in elderly patients. AIM To compare the effects of anesthesia with propofol plus remifentanil and etomidate plus remifentanil on respiratory function and stress in elderly patients with esophageal leukoplakia. METHODS A total of 200 elderly patients (aged 62-73 years) with esophageal leukoplakia who underwent painless gastroscopy at the Endoscopy Center of our hospital from April 2018 to October 2018 were enrolled. The patients were randomly divided into either a control group or a study group, with 100 patients in each group. The control group was anesthetized with propofol and remifentanil, and the study group was anesthetized with etomidate and remifentanil. Serum oxygen saturation (SPO2) and stress hormones (adrenocorticotropic hormone, glucocorticoid, and angiotensin) before and at the end of treatment were compared between the two groups. Hemodynamics during treatment, adverse reactions during treatment, and the difference in time to recovery of spontaneous breathing time were also compared. RESULTS Serum levels of stress hormones in the two groups were comparable before treatment. At the end of treatment,serum levels of stress hormones (adrenocorticotropic hormone, glucocorticoid, and angiotensin) in the study group were significantly lower than those in the control group (P < 0.05). Hemodynamics was more stable in the study group (P < 0.05). SPO2 was significantly higher in the study group than in the control group (P < 0.05). The rate of adverse reactions was significantly reduced in the study group (P < 0.05). However, the time to recovery of spontaneous breathing was significantly shorter in the control group than in the study group (P < 0.05). CONCLUSION Compared with anesthesia with propofol plus remifentanil, etomidate plus remifentanil in elderly patients with esophageal leukoplakia can reduce inflammatory factors and stress hormones more significantly, maintain hemodynamics and intraoperative blood oxygenation saturation more stably, and have fewer adverse reactions, but is associated with longer time to recovery of spontaneous breathing.