阿芬太尼复合丙泊酚用于老年患者无痛胃镜检查的临床研究

Clinical trial of alfentanil combined with propofol in the treatment of elderly patients undergoing painless gastroscopy

目的观察不同剂量阿芬太尼注射液复合丙泊酚注射液用于老年无痛胃镜检查患者的临床效果及安全性。方法将拟进行无痛胃镜检查老年患者用随机数字表分为低、中和高剂量组。低剂量组给予5μg·kg^(-1)阿芬太尼和2 mg·kg^(-1)丙泊酚,中剂量组给予7μg·kg^(-1)阿芬太尼和2 mg·kg^(-1)丙泊酚,高剂量组给予9μg·kg^(-1)阿芬太尼和2 mg·kg^(-1)丙泊酚。比较3组患者的麻醉和苏醒情况、生命体征以及药物不良反应发生率。结果低、中和高剂量组各纳入26例。低、中和高剂量组的丙泊酚追加例数分别为10例(38.46%)、4例(15.38%)和1例(3.85%),丙泊酚用量分别为(126.37±19.56)、(104.68±15.74)和(102.49±14.82)mg,检查时间分别为(8.91±1.63)、(8.03±1.45)和(7.86±1.38)min,睁眼时间分别为(2.35±0.72)、(1.86±0.51)和(1.57±0.45)min,离院时间分别为(16.43±3.19)、(14.70±2.68)和(14.26±2.53)min,中、高剂量组的上述指标与低剂量组比较,差异均有统计学意义(均P<0.05)。与给药前1 min(T_(0))相比,低剂量组进镜至咽喉(T_(1))、进镜至十二指肠(T_(2))和检查结束(T_(3))时的心率(HR)和平均动脉压(MAP)均明显降低(均P<0.05),中、高剂量组T_(1)、T_(2)、T_(3)时的MAP均明显降低(均P<0.05);且与低剂量组相比,中、高剂量组T_(1)、T_(2)、T_(3)时的MAP降低幅度均明显减小(均P<0.05)。与检查前相比,3组检查后血清超氧化物歧化酶(SOD)活性均显著降低(均P<0.05),血清皮质醇(Cor)和去甲肾上腺素(NE)水平均显著升高(均P<0.05),且与低剂量组相比,中、高剂量组的SOD活性降低幅度均明显减小,MDA和NE水平升高幅度均明显减小(均P<0.05)。结论老年人群胃镜检查采用阿芬太尼复合丙泊酚麻醉具有良好镇痛效果和安全性,有利于减少丙泊酚用药剂量,阿芬太尼剂量为7μg·kg^(-1)时氧化应激水平和药物不良反应发生率较低,在安全性方面具有明显优势。

Objective To observe the application effects and safety of different doses of alfentanil combined with propofol in elderly patients undergoing painless gastroscopy.Methods The elderly patients were divided into low-dose group,middle-dose group and high-dose group according to the random number table method.All patients underwent gastroscopy after anesthesia with alfentanil and propofol.Low-dose group was given 5μg·kg^(-1) alfentanil+2 mg·kg^(-1) propofol;middle-dose group was given 7μg·kg^(-1) alfentanil+2 mg·kg^(-1) propofol;high-dose group was given 9μg·kg^(-1) alfentanil+2 mg·kg^(-1) propofol.The anesthesia and recovery,vital signs and incidence of adverse drug reactions were compared among the three groups.Results There were 26 cases in each group.The number of cases with additional propofol in low-dose group,middle-dose group and high-dose group were 10 cases(38.46%),4 cases(15.38%)and 1 case(3.85%);the dosages of propofol were(126.37±19.56),(104.68±15.74)and(102.49±14.82)mg;the examination time were(8.91±1.63),(8.03±1.45)and(7.86±1.38)min;the eye opening times were(2.35±0.72),(1.86±0.51)and(1.57±0.45)min;the hospital discharge times were(16.43±3.19),(14.70±2.68)and(14.26±2.53)min respectively,and there were statistically significant differences between middle-dose group,high-dose group and low-dose group(all P<0.05).Compared with 1 min before administration(T_(0)),the heart rate(HR)and mean arterial pressure(MAP)in low-dose group were significantly decreased at the time of gastroscope entering the throat(T_(1)),at the time of gastroscope entering the duodenum(T_(2))and at the end of the examination(T_(3))(all P<0.05).The MAP in middle-dose group and high-dose group was reduced significantly at T_(1),T_(2) and T_(3)(all P<0.05),and the decrease of MAP at T_(1),T_(2) and T_(3) in middle-dose group and high-dose group was declined compared to low-dose group(all P<0.05).Compared with before examination,serum superoxide dismutase(SOD)activity in the three groups after examination was significantly decreased,while serum cortisol(Cor)and norepinephrine(NE)levels were significantly increased(all P<0.05),and compared with low-dose group,the decrease of SOD activity in middle-dose group and high-dose group was decreased,and the increases of MDA and NE were reduced(all P<0.05).Conclusion Alfentanil combined with propofol has good analgesic effects and safety in painless gastroscopy of elderly population,and it can help reduce the dose of propofol.The oxidative stress level and incidence rates of adverse drug reactions are lower when the dose of alfentanil was 7μg·kg^(-1),which has obvious advantages in safety.