对比分析丙泊酚/依托咪酯混合液分别联合艾司氯胺酮、盐酸舒芬太尼在无痛胃肠镜检查中的应用

Comparative Analysis of the Application of Propofol/Etomidate Mixture in Combination with Esketamine and Sufentanil Hydrochloride in Painless Gastrointestinal Microscopy

目的:探讨对比分析丙泊酚/依托咪酯混合液分别联合艾司氯胺酮、盐酸舒芬太尼在无痛胃肠镜检查中的应用效果。方法:选取我院2022年1月到2022年12月收治的80例行无痛胃肠镜检查患者作为研究对象,应用随机数字表法将所有患者分为观察组与对照组,每组40例。对照组患者应用丙泊酚/依托咪酯混合液+盐酸舒芬太尼进行静脉麻醉,观察组应用丙泊酚/依托咪酯混合液+艾司氯胺酮进行静脉麻醉,对比两组患者入室时基础值(T_(1))、开始镇静时(T_(2))、胃镜置入后(T_(3))、肠镜置入后(T_(4))、操作结束即刻(T_(5))五个不同时间血流动力学指标变化,并对比患者麻醉起效时间、麻醉药追加次数、追加麻醉药总量、意识恢复时间、PACU停留时间,对比检查不同时间认知功能情况以及不良反应发生率。结果:两组患者T_(1)时间舒张压(SBP)、收缩压(DBP)、平均动脉压(MAP)、心率(HR)对比无明显差异(P>0.05),观察组患者同组间T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时间SBP、DBP、MAP、HR对比无明显差异(P>0.05),对照组T_(1)到T_(2)时间SBP、DBP、MAP、HR水平降低,到T_(3)和T_(4)时间升高,T_(5)时间恢复平稳,且观察组与对照组相比T_(2)、T_(3)、T_(4)时间SBP、DBP、MAP水平对比差异显著,观察组低于对照组,T_(3)时间观察组HR低于对照组(P<0.05);观察组麻醉起效时间、麻醉药追加次数、追加麻醉药总量、意识恢复时间、PACU停留时间显低于对照组(P<0.05);两组患者检查后6 h S100B蛋白明显升高,检查后1 d的S100B蛋白逐渐降低,且观察组低于对照组,检查后6 h褪黑素明显降低,检查后1 d的褪黑素逐渐升高,观察组高于对照组(P<0.05);观察组患者不良反应发生率明显低于对照组(P<0.05)。结论:丙泊酚/依托咪酯混合液联合艾司氯胺酮与丙泊酚/依托咪酯混合液联合盐酸舒芬太尼对于无痛胃肠镜检查麻醉效果显著,能够改善患者血流动力学指标波动,减少麻醉药追加次数,且麻醉起效快,苏醒质量好,另外能够进一步改善患者检查后认知功能情况,安全性较高。

Objective:To compare and analyze the application effects of propofol/etomidate mixture in combination with Esketamine and sufentanil hydrochloride in painless gastroscopy.Methods:80 patients admitted to our hospital for painless gastroscopy from January 2022 to December 2022 were selected as study subjects,and the random number table method was applied to divide all patients into observation group and control group,40 cases in each group.The patients in the control group were anesthetized intravenously with propofol/etomidate mixture+sufentanil hydrochloride,and the patients in the observation group were anesthetized intravenously with propofol/etomidate mixture+esketamine,and the hemodynamic parameters were compared between the two groups at five different times:basal values at the time of admission(T_(1)),at the beginning of sedation(T_(2)),after gastroscopy insertion(T_(3)),after enteroscopy insertion(T_(4)),and immediately after the operation(T_(5)).The hemodynamic parameters were compared with the onset of anesthesia,the number of additional anesthetics,the total amount of additional anesthetics,the time of recovery of consciousness,and the time of PACU stay,and the cognitive function and the incidence of adverse effects at different times.Results:There was no significant difference in the comparison of diastolic blood pressure(SBP),systolic blood pressure(DBP),mean arterial pressure(MAP),and heart rate(HR)at T_(1) time between the two groups(P>0.05),and there was no significant difference in the comparison of SBP,DBP,MAP,and HR at T_(1),T_(2),T_(3),T_(4),and T_(5) time between the same groups of patients in the observation group(P>0.05),and the comparison of SBP,DBP,MAP,and HR at T_(1) to T_(2) time in the control group,MAP,and HR levels decreased in the control group from T_(1) to T_(2) time,increased to T_(3) and T_(4) time,and restored smoothly at T_(5) time,and there were significant differences in the comparison of SBP,DBP,and MAP levels in the observation group compared with the control group at T_(2),T_(3),and T_(4) time,and the HR in the observation group was lower than that in the control group at T_(3) time(P<0.05);The onset of anesthesia,the number of additional anesthetics,the total amount of additional anesthetics,the time of recovery of consciousness,and the time of PACU stay in the observation group were significantly lower than those in the control group(P<0.05);The S100B protein in the two groups increased significantly at 6 hours after examination,and the S100B protein gradually decreased at 1 days after examination,and the observation group was lower than the control group.Melatonin significantly decreased at 6 hours after examination,and the melatonin gradually increased at 1 days after examination,and the observation group was higher than the control group(P<0.05);The incidence of adverse reactions in the observation group was lower than that in the control group(P<0.05).Conclusion:Propofol/etomidate mixture combined with Esketamine and propofol/etomidate mixture combined with sufentanil hydrochloride has a significant anesthetic effect on painless gastrointestinal endoscopy,can improve the fluctuation of hemodynamic parameters in patients,reduce the number of additional anesthetic drugs,and have a rapid onset of anesthesia,good quality of recovery,in addition,can further improve the cognitive function of patients after examination,with high safety.