依托咪酯复合右美托咪定麻醉用于老年患者内镜逆行胰胆管造影术的效果及对认知功能的影响

Anesthetic effect of etomidate combined with dexmedetomidine on elderly patients undergoing endoscopic retrograde cholangiopancreatography and its influence on cognitive function

目的:研究依托咪酯复合右美托咪定麻醉用于老年患者内镜逆行胰胆管造影术(ERCP)的效果及对认知功能的影响。方法:抽取2019年6月至2021年2月于太原钢铁(集团)有限公司总医院接受ERCP治疗的老年患者80例,按随机数字表法分为对照组和复合组,每组40例。对照组给予依托咪酯麻醉,复合组给予依托咪酯复合右美托咪定麻醉。比较两组患者的麻醉恢复指标,比较两组麻醉诱导前(T0)、内镜置入口咽部时(T1)、导管插入十二指肠乳头即刻(T2)、手术结束即刻(T3)、苏醒即刻(T4)及术后30 min(T5)的血流动力学及应激反应水平,比较两组治疗前后的认知功能,评估麻醉安全性。结果:两组麻醉恢复指标水平比较差异未见统计学意义( P>0.05)。两组患者心率和血氧饱和度(SpO 2)在组间、时间及交互效应上比较差异均有统计学意义( P均<0.05),平均动脉压(MAP)在时间及交互效应上比较差异有统计学意义( P<0.05),肾上腺素(EPI)、去甲肾上腺素(NE)水平以及简易精神状态检查表(MMSE)、蒙特利尔认知评估量表(MoCA)评分在组间、不同时间点比较差异有统计学意义( P<0.05)。T1、T2时,复合组MAP、心率均低于对照组( P均<0.05);T1时,复合组SpO 2水平高于对照组( P<0.05);T2、T3、T5时,复合组EPI、NE水平均低于对照组( P均<0.05);术后1、3 d,复合组MMSE、MoCA评分均高于对照组( P均<0.05)。两组不良反应发生率比较差异未见统计学意义( P>0.05)。 结论:右美托咪定复合依托咪酯用予老年ERCP患者的麻醉安全、有效,可维持患者血流动力学稳定性,减轻应激反应和认知功能损伤。

Objective To study the anesthetic effect of etomidate combined with dexmedetomidine on elderly patients undergoing endoscopic retrograde cholangiopancreatography(ERCP)and its influence on cognitive function.Methods Eighty elderly patients who underwent ERCP in General Hospital of Taiyuan Iron and Steel(Group)Co.,Ltd.from June 2019 to February 2021 were selected,and they were divided into control group and combined group by random number table method,with 40 patients in each group.Patients in the control group were given etomidate anesthesia,while patients in the combined group were given etomidate combined with dexmedetomidine anesthesia.The anesthesia recovery indexes of the two groups were compared.The hemodynamics and stress response levels of the two groups were compared before anesthesia induction(T0),at the time of endoscopic placement in the entrance pharynx(T1),immediately after catheter insertion into the duodenal papilla(T2),immediately after operation(T3),immediately after awakening(T4),and 30 minutes after operation(T5).And the preoperative and postoperative cognitive function of the two groups were compared.The safety of anesthesia of the two groups were evaluated.Results There was no significant difference in anesthesia recovery indexes between the two groups(P>0.05).There was no significant difference in heart rate(HR)and blood oxygen saturation(SpO2)between the two groups in terms of inter-group effect,time effect and interaction effect(all P<0.05).There were significant differences in mean arterial pressure(MAP)between the two groups in terms of time effect and interaction effect(P<0.05).There were significant differences in epinephrine(EPI)level,norepinephrine(NE)level,mini mental state examination(MMSE)scores,and Montreal cognitive assessment scale(MoCA)scores between the two groups and at different time points(P<0.05).The combined group had lower MAP and HR than the control group at T1 and T2,and had higher SpO2 than the control group at T1(all P<0.05).The levels of EPI and NE in the combined group were lower than those in the control group at T2,T3 and T5(all P<0.05).The MMSE and MoCA scores in the combined group were higher than those in the control group 1 and 3 days after operation(all P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Etomidate combined with dexmedetomidine anesthesia is a safe and effective anesthesia regimen for elderly patients undergoing ERCP,which can maintain hemodynamic stability,and reduce stress response and cognitive impairment.