复合纳布啡时不同年龄对无痛胃肠镜检查患者丙泊酚药效学影响

Effect of different ages on the pharmacodynamics of propofol in patients received painless gastroscopy when propofol combined with nalbuphine

目的探讨不同年龄患者无痛胃肠镜检查时复合纳布啡对丙泊酚药效学影响。方法选择2018年1月—2019年6月在本院进行无痛胃肠镜检查,以年龄段1︰1︰1,性别匹配原则且美国麻醉师协会(ASA)分级为Ⅰ级或Ⅱ级的96例患者作为研究对象,根据患者不同年龄将其分为A组(18-39岁)、B组(40-64岁)和C组(65-85岁)三组,每组各32例。三组患者的丙泊酚初始效应室靶浓度分别为2.5、2.0、1.5μg/ml,待患者效应室和血浆浓度均平衡后开始静脉注射0.10 mg/kg纳布啡。分别于麻醉诱导前(T0)、检查开始(T1)、肠镜置入乙状结肠、回盲瓣时(T2、T3)、体动前、后(T4、T5)以及检查结束(T6)时刻记录患者的血氧饱和度(SPO)、平均血压(MBP)、心率(HR),并计算半数有效AAI(AAI)、半数有效效应室浓度(EC_(50))。比较三组患者术后认知能力恢复情况及不良反应发生情况。结果A组、B组、C组患者的EC_(50)分别为4.32(95%CI为4.01-4.70)μg/ml、3.51(95%CI为3.08-3.92)μg/ml、2.82(95%CI为2.38-3.15)μg/ml;另外A组、B组、C组患者的AAI分别为22.08(95%CI为18.41-24.77)、25.02(95%CI为20.18-28.95)、29.84(95%CI为27.68-33.59),且三组患者在行胃肠镜检查过程中的发生阳性反应患者的AAI高于阴性患者,患者体动前AAI相比体动后更低(P<0.05);C组患者的短暂性低血压以及呼吸抑制高于A组、B组,差异有统计学意义(P<0.05);但是三组患者恶心呕吐和嗜睡比较,差异无统计学意义(P>0.05);A组、B组患者不良反应发生率(3.12%、12.50%)均低于C组(68.75%),差异有统计学意义(P<0.05);三组患者的离院时长、认知功能恢复至术前水平时长、自由行动时长、OAA/S评分比较,差异有统计学意义(P<0.05);且B组、C组患者的离院时长、认知功能恢复至术前水平时长、自由行动时长高于A组,C组患者又高于B组,差异有统计学意义(P<0.05)。结论复合纳布啡时,年龄是影响无痛胃肠镜检查患者丙泊酚药效学的重要影响因素。

Objective To investigate the influence of nalbuphineon the pharmacodynamics of propofol in patients of different agesundergoing painless gastroscopy.Methods A total of 96 patients who underwent painless gastroscopy in our hospital from January 2018 to June 2019 were selected as study objects,and they were divided into group A(18-39 years old),group B(40-64 years old),and group C(65-85 years old),32 cases in each group.The ratio of each age groups was 1︰1︰1,sex ratio abide matching principle,and the patients were of grade I or II according to American society of anesthesiologists(ASA).The target concentrations of propofol of initial effect chamberin the three groups of patients were 2.5,2.0,and 1.5μg/ml,respectively.Once the effect room and plasma concentrations of patients were in balance,0.1 mg/kg nalbuphine was injected intravenously.Blood oxygen saturation(SPO),mean blood pressure(MBP),and heart rate(HR)were measured at the time points before the induction of anesthesia(T),the start of the examination(T),when the colonoscopy is placed in the sigmoid colon or the ileocecal valve(T,T),before or after the body movement(T,T)and the time of the end of the examination(T6).Half effectiveauditory evoked potential index(AAI)and the half effective effect chamber concentration(EC_(50))were calculated.In addition,the recovery of cognitive ability and the occurrence of adverse reactions were observed and compared.Results The EC_(50)of patients in groups A,B,and C were 4.32(95%CI 4.01 to 4.70)μg/ml,3.51(95%CI 3.08 to 3.92)μg/ml,2.82(95%CI 2.38 to 3.15)μg/ml.The AAIof patients in group A,group B,and group C were 22.08(95%CI 18.41-24.77)and 25.02(95%CI 20.18-28.95),29.84(95%CI 27.68-33.59).In addition,the AAI of patients with positive reactions during gastrointestinal examination of the three groups was higher than that of the negative patients,and the AAI before the body movement was lower than that after the body movement(P<0.05).The incidence of transient hypotension and respiratory depression in group C were higher than those in group A and B,and the differences were statistically significant(P<0.05).However,there was no significant difference in nausea,vomiting and sleepiness among the three groups(P>0.05).The incidence of adverse reactions in group A and group B(3.12%12.50%)were lower than that in group C(68.75%),and the differences were statistically significant(P<0.05).There were statistically significant differences in the length of hospital discharge,the length of cognitive function recovery to the preoperative level,the length of free movement and OAA/S score among the three groups(P<0.05).In addition,patients in group B and group C had longer length of hospital discharge,timeto recover their cognitive function to the preoperative level,andlength of free movement than those in group A,and those of group C were longer than those in group B,with statistically significant differences(P<0.05).Conclusions Age is an important factor affects the pharmacodynamics of propofol in patients undergoing painless gastroscopy when combined with nalbuphine.