右美托咪定联合丙泊酚对无痛胃肠镜检查后患者早期认知功能的影响

Early cognitive function changes after dexmedetomidine added to propofol-based sedation for gastrointestinal endoscopy

目的评价右美托咪定联合丙泊酚对门诊无痛胃肠镜检查后患者早期认知功能的影响。方法选取温州医科大学附属第一医院2019年5至9月行无痛胃肠镜检查的268例患者按随机数字表法分为C_(30)组(76例)、C_(60)组(62例)、D_(30)组(64例)和D_(60)组(66例)。所有患者在检查前接受蒙特利尔认知评估(MoCA)评分。D_(30)组和D_(60)组在麻醉前10 min内连续静脉泵注右美托咪定0.3μg/kg,C_(30)组和C_(60)组泵注等量0.9%氯化钠注射液。4组患者检查结束在改良后的警觉/镇静观察评分(OAA/S)评分=5(对正常语调说出的名字有反应)后30 min(C_(30)组和D_(30)组)或60 min(C_(60)组和D_(60)组)进行MoCA评分。结果4组患者检查前MoCA评分差异均无统计学意义(均P>0.05),检查后MoCA评分均明显下降(均P<0.01),其中C_(60)组、D_(30)组和D_(60)组均高于C_(30)组(均P<0.01),D_(30)组和D_(60)组均高于C_(60)组(均P<0.01),但D_(30)组与D_(60)组比较差异无统计学意义(P>0.05)。认知功能障碍发生率C_(30)组最高(56.6%),C_(60)组、D_(30)组和D_(60)组较C_(30)组明显下降(均P<0.05),而D_(30)组和D_(60)组均明显低于C_(60)组(均P<0.05)。4组不同性别患者检查前后MoCA评分差异均无统计学意义(均P>0.05)。结论右美托咪定联合丙泊酚用于无痛胃肠镜检查,可改善患者早期认知功能,降低认知功能障碍的发生率。

Objective To investigate the effect of sedation with propofol plus dexmedetomidine on early cognitive function in patients undergoing gastrointestinal endoscopy.Methods The clinical data of 268 patients who underwent painless gastrointestinal endoscopy in the First Affiliated Hospital of Wenzhou Medical University from May to September 2019 were reviewed.Patients were randomly allocated into group C30(n=76),group C60(n=62),group D30(n=64)and group D60(n=66).Patients in group D30 and group D60 received a continuous intravenous pumping of dexmedetomidine at a dose of 0.3μg/kg within 10 min before anaesthesia,while patients in group C30 and group C60 received an equal volume of normal saline instead.MoCA tests were performed before sedation and at discharge.Results There was no significant difference in MoCA scores before sedation among groups.Compared to baseline scores,the MoCA scores were decreased in all groups after endoscopy(P<0.01).Compared to group C30,the MoCA scores were higher in group C60 and group D30 and group D60(P<0.01),and MoCA scores in group D30 and group D60 were higher than those in group C60(P<0.01).Incidence of cognitive impairment in group C30 was 56.6%,which ranks the highest among the four groups(P<0.01).Compared to group C30,incidence of cognitive impairment was significantly decreased in group C60,group D30 and group D60(P<0.01),while the incidence in group D30 and group D60 was lower than that in group C60(P<0.01).There was no significant difference in MoCA scores between the genders in all group(P>0.05).Conclusion Adding dexmedetomidine to sedation for gastrointestinal endoscopy can improve early cognitive function and reduce incidence of cognitive impairment in patients undergoing painless gastrointestinal endoscopy.