氢吗啡酮复合丙泊酚在无痛胃肠镜中的应用

Application of hydromorphone combined with propofol in painless gastrointestinal endoscopy

目的探讨氢吗啡酮复合丙泊酚用于无痛胃肠镜的安全性和有效性,为氢吗啡酮的临床应用提供参考依据。方法选取2019年9月至2020年7月于北部战区空军医院内窥镜中心行择期无痛胃肠镜的患者86例,按照随机数字表法分为单纯丙泊酚组(n=43,P组)和丙泊酚复合氢吗啡酮组(n=43,H组)。比较两组患者不同时间点(T0麻醉前5 min,T1睫毛反射消失时,T2胃镜置入时,T3肠镜通过肝曲、T4脾曲,T5术毕撤出镜子后)血流动力学的变化、丙泊酚的用量和苏醒时间,比较两组患者的麻醉效果(检查过程中是否发生体动、呛咳、低血压、低氧血症)和不良反应(检查结束后患者呼吸抑制、头晕、恶心呕吐、腹痛)的发生情况及术后VAS、MMES评分。结果两组患者在麻醉后各时点的SBP/DBP均较麻醉前降低,T2、T3、T4时HR较T0有所升高。H组在T1、T5时点SBP/DBP、HR下降程度明显低于P组(P<0.05),P组T2、T3、T4时点HR高于H组(P<0.05);H组在术中体动、呛咳、低血压、低氧血症的发生率和术后头晕、腹痛、恶心呕吐的发生率均低于P组(P<0.05);H组丙泊酚用量、苏醒时间、VAS评分均低于P组(P<0.05),H组MMES评分与P组比较,差异无统计学意义(P>0.05)。结论氢吗啡酮复合丙泊酚用于无痛胃肠镜患者的麻醉效果良好,不良反应少,术后舒适程度更高。

Objective To explore the safety and effectiveness of hydromorphone combined with propofol for painless gastrointestinal endoscopy,and provide a reference for the clinical application of hydromorphone.Methods A total of 86 patients who underwent elective painless gastrointestinal endoscopy at the Endoscopy Center of the PLA Air Force Hospital of the Northern War Zone from September 2019 to July 2020 were selected and divided into the propofol-only group(n=43,P group)and propofol combined with hydromorphone group(n=43,H group)according to the random number table.The hemodynamic changes at different time points[5 min before anesthesia(T0),when eyelash reflex disappeared(T1),when gastroscope was inserted(T2),when enteroscope went through liver flexure(T3),when it went through splenic flexure(T4),and after removing the endoscope(T5)],the dosage of propofol,and the recovery time were compared between the two groups.The anesthetic effects(whether physical movement,coughing,hypotension or hypoxemia occurred during the examination),the incidence of adverse reactions(respiratory depression,dizziness,nausea,vomiting,abdominal pain in the patients after examination),and postoperative VAS and MMES scores were compared between the two groups.Results The SBP/DBP of patients at each time point after anesthesia were lower than that before anesthesia,and the HR at T2,T3,and T4 was higher than that at T0.The decline of SBP/DBP and HR at T1 and T5 in group H was significantly lower than that in group P(P<0.05),and HR at T2,T3,and T4 in group P was higher than that in group H(P<0.05).The incidence of intraoperative body movement,coughing,hypotension and hypoxemia,and the incidence of postoperative dizziness,abdominal pain,nausea and vomiting in group H were lower than those in group P(P<0.05);The dosage of propofol,recovery time and VAS score in group H were lower than those in group P(P<0.05),while there was no significant difference in MMES score between group H and group P(P>0.05).Conclusion Hydromorphone combined with propofol has good anesthetic effects on patients undergoing painless gastrointestinal endoscopy,with fewer adverse reactions and higher postoperative comfort than propofol.