纳洛酮对老年患者无痛肠镜麻醉后苏醒质量和认知功能的影响

Effect of naloxone on awakening quality and cognitive function of aged patients undergoing painless colonoscopy

目的探讨纳洛酮对无痛肠镜检查老年患者采用地佐辛联合丙泊酚麻醉后苏醒质量和认知功能的影响。方法将拟行无痛肠镜检查的72例老年患者随机分为观察组(n=36)和对照组(n=36)。2组均给予地佐辛0.05 mg/kg,丙泊酚1~2 mg/kg行静脉麻醉。检查结束,观察组静脉注射纳洛酮0.2 mg,对照组静脉注射等量生理盐水。记录麻醉前、麻醉后、镜检前、镜检结束、离院前的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)、苏醒时间、定向力恢复时间、正常行走时间及术毕5、10 min Ramsay镇静评分。比较2组恶心、呕吐、头晕、腹痛等不良反应情况,并采用简易精神状态量表(MMSE)评分评价检查前和检查结束30 min的认知功能。结果与对照组比较,观察组定向力恢复时间、正常行走时间缩短,术毕Ramsay镇静评分及头晕发生率降低,差异有统计学意义(P<0.05)。2组患者检查结束30 min的MMSE评分较术前降低,但2组比较差异无统计学意义(P>0.05)。结论老年患者行无痛肠镜检查时,丙泊酚复合地佐辛麻醉术毕给予纳洛酮有助于提高苏醒质量,留院观察时间短,不良反应发生率较低,对术后早期认知功能无显著影响。

Objective To investigate the effect of naloxone on awakening quality and cognitive function for aged patients undergoing dezocine and propofol anesthesia under painless colonoscopy.Methods A total of 72 aged patients under painless colonoscopy were randomly divided into observation group(n=36)and control group(n=36).All patients received intravenous anesthesia with propofol(0.05 mg/kg)and dezocine(1~2 mg/kg).The observation group was intravenous injrcted 0.2 mg naloxone and the control group was intravenous injrcted normal saline in the same amount after examination.The mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO2),awaken time,recovery time of orientation,time of normally walking and Ramsay sedation score at 5 and 10 min after surgery before anesthesia,after anesthesia,before microscopic examination,after microscopic examination,before leaving the hospital were recorded.The incidence of side effects such as postoperative nausea and vomiting,and dizziness as well as abdominal pain were recorded,and cognitive function before and 30 minutes after the examination was assessed by Mini-Mental State Examination(MMSE).Results Compared with the control group,recovery time of orientation and time of normally walking were significantly shortened,and Ramsay sedative scores after surgery and the incidence of postoperative dizziness were significantly reduced(P<0.05).MMSE score of both groups decreased at 30 min after examination,but there was no significant difference between the two groups(P>0.05).Conclusion Naloxone for aged patients after undergoing dezocine and propofol anesthesia provides a high recovery quality in painless colonoscopy examination,and can shorten hospital discharge time,reduce the incidence of side effects.There was no significant effect on early cognitive function in aged patients after the procedure.