右美托咪定复合丙泊酚和纳布啡对老年无痛胃镜检查患者认知功能的影响观察

Effect of Dexmedetomidine Combined with Propofol and Nalbuphine on Cognitive Function in Elderly Patients Undergoing Painless Gastroscopy

目的:观察右美托咪定复合丙泊酚和纳布啡对老年无痛胃镜检查患者认知功能的影响。方法:行无痛胃镜检查的老年患者180例随机分为对照组、咪达唑仑组、右美托咪定组,每组60例。对照组静脉注射等量0.9%氯化钠溶液,咪达唑仑组静脉注射1 mg咪达唑仑,右美托咪定组微泵静脉注入0.2μg·kg^(-1)右美托咪定。之后3组均静滴5~6 mg纳布啡、静注1.5 mg·kg^(-1)丙泊酚。观察患者入手术室即刻(T0)、意识消失时(T1)和检查结束时(T2)的生命体征。记录患者麻醉和胃镜检查相关指标以及药品不良反应。于术前1 d、术后1 d及术后3 d行简易认知状态检查(MMSE)量表评分,检测患者S-100β蛋白和神经元特异性烯醇化酶(NSE)水平。结果:T1时3组平均动脉压(MAP)、心率(HR)及呼吸频率(RR)均较T0时降低(P<0.05),而T2时3组上述指标则较T1时升高(P<0.05),但与T0时无明显差异(P>0.05);T1时咪达唑仑组RR低于对照组和右美托咪定组(P<0.05),T2时3组MAP、HR及RR比较差异无统计学意义(P>0.05);3组SpO;水平在不同时点均未发生明显变化(P>0.05)。咪达唑仑组、右美托咪定组的麻醉诱导时间、体动反应次数、丙泊酚追加用量均低于对照组(P<0.05),而这两组间差异无统计学意义(P>0.05);对照组、右美托咪定组的苏醒时间、定向力恢复时间短于咪达唑仑组(P<0.05),且对照组、右美托咪定组间比较差异无统计学意义(P>0.05)。3组术后1 d、术后3 d的MMSE评分均较术前1 d明显下降(P<0.05),血清S-100β蛋白、NSE水平则较前明显升高(P<0.05);而术后3 d时对照组、咪达唑仑组MMSE评分较术后1 d时升高(P<0.05)、血清S-100β蛋白、NSE水平则下降(P<0.05),右美托咪定组无明显变化(P>0.05)。术后1 d和术后3 d,右美托咪定组的MMSE评分高于对照组和咪达唑仑组(P<0.05),血清S-100β蛋白、NSE水平则低于对照组和咪达唑仑组(P<0.05)。右美托咪定组术后1 d和术后3 d的认知功能障碍(POCD)发生率均明显低于对照组和咪达唑仑组(P<0.05)。3组药品不良反应均较轻,发生率差异无统计学意义(P>0.05)。结论:右美托咪定复合丙泊酚和纳布啡的镇静/麻醉方案用于老年无痛胃镜检查安全有效,尤其对患者认知功能影响较小,具有良好的推广应用价值。

Objective:To observe the effect of dexmedetomidine combined with propofol and nalbuphine on cognitive function in elderly patients undergoing painless gastroscopy. Methods:A total of 180 elderly patients undergoing painless gastroscopy were randomly divided into control group, midazolam group and dexmedetomidine group, with 60 patients in each group. The control group was intravenously injected with 0.9% sodium chloride solution, midazolam group was intravenously injected 1 mg midazolam, dexmedetomidine group was intravenously injected with 0.2 μg·kg^(-1) dexmedetomidine by micropump. After that, the three groups were all given 5-6 mg nalbuphine intravenously and 1.5 mg·kg^(-1) propofol intravenously. The vital signs of the patients were observed immediately after entering the operating room(T0), when consciousness disappeared(T1), and at the end of the examination(T2). Anesthesia and endoscopic indicators and adverse drug reactions were recorded. MMSE scale score and S-100β protein and neuron-specific enolase(NSE) levels were measured 1 d before surgery, 1 d after surgery and 3 d after surgery. Results:At T1, MAP, HR and RR among the three groups were lower than those at T0(P<0.05);at T2, MAP, HR and RR among the three groups were higher than those at T1(P<0.05), but there were no statistically significant differences compared with those at T2(P>0.05). RR of midazolam group at T1 was lower than that of control group and dexmedetomidine group(P<0.05), MAP, HR and RR of the three groups at T2 were not statistically different(P>0.05). There was no significant difference in SpO_(2) between the three groups at the same time point or at different time points within the group(P>0.05). Compared with those in the control group, the anesthetic induction time, motor response times and the additional dosage of propofol in midazolam group and dexmedetomidine group were lower(P<0.05), and there was no statistical difference between midazolam group and dexmedetomidine group(P>0.05). The awakening time, the directional force recovery time in the control group and the dexmedetomidine group were shorter than those in the midazolam group(P<0.05), and there was no statistical difference between the control group and dexmedetomidine group(P>0.05). Compared with 1 d before surgery, MMSE score was significantly decreased 1 d and 3 d after surgery(P<0.05), while serum S-100β protein and NSE levels were significantly increased in the three groups(P<0.05). Compared with 1 d after surgery, MMSE score in control group and midazolam group increased(P<0.05), serum S-100β protein and NSE levels decreased(P<0.05), while no significant change was observed in dexmedetomidine group(P>0.05). Compared with the control group and midazolam group, MMSE score of dexmedetomidine group increased 1 d and 3 d after surgery(P<0.05), while serum S-100β protein and NSE levels decreased(P<0.05). The incidence of POCD 1 d and 3 d after surgery in dexmedetomidine group was significantly lower than those in the control group and midazolam group(P<0.05). The adverse reactions in the three groups were mild and the incidence was not statistically significant(P>0.05). Conclusion:Dexmedetomidine combined with propofol and nalbuphine is safe and effective for painless gastroscopy in the elderly, has little affect on the cognitive function of the patients, and has good promotion and application value.