丙泊酚复合右美托咪定或咪达唑仑在老年人无痛胃肠镜检中的应用

Application of Propofol Combined with Dexmedetomidine or Midazolam in Painless Gastrointestinal Endoscopy in the Elderly

目的探讨丙泊酚复合右美托咪定(dexmedetomidine,Dex)或咪达唑仑在老年人无痛胃肠镜检中对临床效果、术后认知功能及不良反应的影响。方法选取2018年9月至2019年4月无痛胃肠镜联合检查的老年患者340例,前250例患者随机分五组(n=50),Dex组(D1、D2、D3组),术前15 min分别予0.25μg/kg、0.5μg/kg、0.75μg/kg Dex静脉泵注。咪达唑仑组(M组)0.03 mg/kg术前15 min静脉推注。对照组(C组)予等量0.9%氯化钠溶液。余麻醉方案相同。记录术中生命体、不良反应,得出最佳Dex剂量。后90例随机分3组(n=30),Dex组(D组),咪达唑仑组(M2),对照组(C2),用蒙特利尔认知评估量表(MOCA)评估术前(T0)、苏醒后5 min(T1)、30 min(T2)、1 h(T3)、2 h(T4)、6 h(T5)认知功能情况。结果C组丙泊酚用量最多(P<0.05),D3、M组苏醒时间较D1、D2、C组延长(P<0.05),C组呼吸抑制发生率最高,其次为M组(P<0.05);D3组心动过缓发生率最多,D2组次之(P<0.05);C组体动最多,D3组最少(P<0.05);M2组术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生率高于D组(P<0.05)。结论丙泊酚复合0.5μg/kg右美托咪定,在老年人无痛胃肠镜检查中能减少不良反应与早期POCD的发生。

Objective To investigate the impact of propofol combined with Dexmedetomidine(Dex)or midazolam on the clinical effect,postoperative cognitive function and adverse reactions in elderly's painless gastrointestinal endoscopy.Methods Three hundreds and forty elderly patients who underwent joint painless gastroscopy from September 2018 to April 2019 were selected.Two hundreds and fifty patients were randomly divided into five groups(n=50),Dex group(D1,D2,D3 group)was given intravenous injection of dexmedetomidine 0.25μg/kg,0.5μg/kg,0.75μg/kg respectively(within 15 minutes).In the midazolam group(group M),0.03 mg/kg was injected intravenously 15 minutes before surgery.The control group(group C)was given an equivalent volume of 0.9%sodium chloride solution.The rest of the anesthesia protocol is same.We recorded vital signs and adverse reactions during the operation and got the best Dex dose.The rest 90 patients were randomly divided into 3 groups(n=30),Dex group(D group),midazolam group(M2),and control group(C2).Montreal Cognitive Assessment Scale(MOCA)was used to evaluate cognitive function at preoperative(T0),and 5min(T1),30min(T2),1h(T3),2 h(T4),6 h(T5)after awakening.Results Group C had the largest amount of propofol(P<0.05).The recovery time of D3 and M groups was longer than that of D1,D2 and C(P<0.05).The incidence of respiratory depression was the highest in group C,followed by group M(P<0.05).The incidence of bradycardia in group D3 was the highest,followed by group D2(P<0.05);group C had the most body movements,and group D3 had the least(P<0.05);the incidence of Postoperative cognitive dysfunction(POCD)in group M2 was higher than that in group D(P<0.05).Conclusion Propofol combined with 0.5 ug/kg dexmedetomidine can reduce the occurrence of adverse reactions and early POCD in elderly's painless gastrointestinal endoscopy.