不同剂量芬太尼联合酮咯酸氨丁三醇在老年肥胖无痛胃镜中的应用

Application of different doses of fentanyl combined with ketorolac tromethamine for painless gastroscopy in elderly obese patients

背景无痛胃镜是在全麻下进行的检查技术,具有无痛、时间短、安全等优势,超前镇痛是近年提倡镇痛方案,如酮咯酸氨丁三醇,具有强效镇痛作用,可减少伤害性刺激传入所致中枢敏化,缓解急慢性疼痛,尤适用于围术期镇痛.目的探讨不同剂量芬太尼联合酮咯酸氨丁三醇应用于老年肥胖无痛胃镜的效果及对神经认知紊乱的影响.方法选取2019-03/2021-03我院163例老年肥胖无痛胃肠镜患者,随机数字表法分为A组(n=55)、B组(n=54)、C组(n=54),分别采取小剂量芬太尼+酮咯酸氨丁三醇、中剂量芬太尼+酮咯酸氨丁三醇、大剂量芬太尼+酮咯酸氨丁三醇.统计3组生命体征[平均动脉压(mean artery pressure,MAP)、心率(heart rate,HR)]、意识状态(bispectral index,BIS)、视觉模拟评分法(visual analogue scale,VAS)评分、简易精神状态评价量表(mini-mental state examination,MMSE)、麻醉相关指标(麻醉起效时间、无痛胃镜检查、苏醒时间、麻醉恢复时间)、满意度、不良反应.结果(1)T2、T3时A组MAP低于B组、C组,HR高于B组、C组(P<0.05),T2、T3时B组、C组MAP、HR比较,差异无统计学意义;(2)检查中A组BIS值小于B组、C组(P<0.05),检查中B组、C组BIS值比较,差异无统计学意义;A组清醒后VAS评分高于B组、C组(P<0.05),B组、C组清醒后VAS评分比较,差异无统计学意义;(3)清醒后A组、B组MMSE评分高于C组(P<0.05),清醒后A组、B组MMSE评分比较,差异无统计学意义;(4)B组麻醉起效时间、无痛胃镜检查、苏醒时间、麻醉恢复时间短于A组、C组(P<0.05);(5)A组、B组严重呼吸暂停事件低于C组(P<0.05).结论1μg/kg芬太尼联合酮咯酸氨丁三醇应用于老年肥胖无痛胃镜检查中,可稳定生命体征,缓解疼痛,减少严重呼吸暂停事件,缩短麻醉恢复时间,且对神经认知紊乱影响较小.

BACKGROUND Painless gastroscopy is carried out under general anesthesia with advantages of painlessness,short time,and safety.Advanced analgesia has been advocated in recent years,and analgesia program,such as ketorolac ammonia buttriol,has a strong analgesic effect,can reduce the central sensitization caused by the introduction of harmful stimulus,and relieve acute and chronic pain,which is especially suitable for perioperative analgesia.AIM To investigate the efficacy of different doses of sufentanil combined with ketorolac tromethamine for painless gastroscopy in elderly obese patients and its influence on neurocognitive disorders.METHODS A total of 163 elderly obese who would undergo painless gastroscopy at our hospital from March 2019 to March 2021 were randomly divided into group A(n=55),group B(n=54),and group C(n=54),and they were given low-dose sufentanil+ketorolac tromethamine,medium-dose sufentanil+ketorolac tromethamine,and high-dose sufentanil+ketorolac tromethamine,respectively.Vital signs[mean arterial pressure(MAP)and heart rate(HR)],Ramsay sedation score,visual analog scale(VAS)score,mini-mental state examination(MMSE)score,anesthesia-related indicators(anesthesia onset time,painless gastroscopy,recovery time,and anesthesia recovery time),satisfaction,and adverse reactions were compared among the three groups.RESULTS At the time of inserting gastroscope(T2)and the time of gastroscope entering the opening of the duodenal papilla(T3),the MAP in group A was lower than that of groups B and C,and HR was higher than that of groups B and C(P<0.05);there was no statistical difference in MAP or HR between groups B and C at T2 and T3.The BIS value of group A was lower than those of group B and group C(P<0.05);there was no statistically significant difference in the BIS value between group B and group C during the examination(P>0.05).The VAS score of group A after waking up was higher than those of group B and group C(P<0.05);there was no statistically significant difference in VAS score between group B and group C after waking up(P>0.05).The MMSE scores in groups A and B after waking up were higher than that of group C(P<0.05);there was no statistically significant difference in MMSE score between group A and group B(P>0.05).Anesthesia onset time,painless gastroscopy,awakening time,and anesthesia recovery time were shorter in group B than in group A and group C(P<0.05).The incidence of severe apnea events in group A and group B were lower than that of group C(P<0.05).CONCLUSION Sufentanil 0.15μg/kg combined with ketorolac tromethamine can stabilize vital signs,relieve pain,reduce severe apnea events,shorten anesthesia recovery time,and be effective in painless gastrointestinal endoscopy in elderly obese patients,with minimal impact on neurocognitive disorders.