纳洛酮与舒芬太尼混合输注在老年患者胃食管反流病射频手术的应用

Effectiveness of mixed naloxone and sufentanil infusion in elderly patients undergoing radiofrequency treatment of gastroesophageal reflux disease

目的评价纳洛酮与舒芬太尼混合液在老年患者胃食管反流病射频手术的麻醉效果。方法择期行胃镜下射频治疗的老年患者(年龄≥65)120例随机分为对照组(舒芬太尼复合丙泊酚麻醉)和干预组(舒芬太尼纳洛酮混合液复合丙泊酚麻醉)。记录术中平均血压较基线值波动大于20%的例数、平均动脉压和心率、BIS值;记录苏醒时间、丙泊酚用量和术后1 h痛觉(Visual Analogue Score,VAS)评分等。结果对照组(26例,43%)血压波动大于20%的例数大于干预组(10例,17%)(P=0.001);干预组BIS值高于对照组(P<0.01);干预组丙泊酚的用量小于对照组用量(P<0.01),干预组苏醒时间短于对照组(P<0.01),干预组术后1 h VAS评分低于对照组(P=0.005)。结论纳洛酮舒芬太尼混合输注镇痛效果增强,可使丙泊酚用量减少,血流动力学更稳定,苏醒时间缩短。

Objective To evaluate the efficacy of propofol combined with naloxone and sufentanil mixture in gastroscopic radiofrequency treatment of GERD(Gastroesophageal Reflux Disease)elderly patients.Methods One hundred and twenty elderly patients scheduled for gastroscopic radiofrequency treatment for GERD were randomly divided into control group(sufentanil combined with propofol anesthesia)and intervention group(sufentanil naloxone mixture combined with propofol anesthesia),with 60 in each group.The number of cases with intraoperative blood pressure fluctuation(more than 20%of the basal blood pressure)was observed,and mean arterial pressure,heart rate,and BIS values were compared between the two groups.The time of awakening,propofol dosage,and 1-hour postoperative Visual Analogue Score(VAS)scores were recorded.Results The number of cases with intraoperative blood pressure fluctuation greater than 20%was higher in the control group(26 cases,43%)than that in the intervention group(10 cases,17%)(P=0.001).Intraoperative BIS values were higher in the intervention group than those in the control group(P<0.01).The dosage of propofol in the intervention group was lower than that in the control group(P<0.01),and the awakening time in the intervention group was shorter than that in the control group(P<0.01).The VAS score was lower in the intervention group than that in the control group at 1 hour after surgery(P=0.005).Conclusion Compared to sufentanil/propofol anesthesia,naloxone and sufentanil mixture combined with propofol anesthesia showed more stable intraoperative hemodynamics,shorter time to awakening,and reduced propofol consumption.