丙泊酚复合依托咪酯麻醉对脉搏灌注指数监测下老年胃肠镜检查麻醉效果及安全性的影响

Effect and Safety of Propofol Combined with Etomidate for Sedation on Gastroenteroscopy in Elderly Patients under Pulse Perfusion Index Monitoring

目的 探讨丙泊酚复合依托咪酯麻醉对脉搏灌注指数(PI)监测下老年胃肠镜检查麻醉效果及安全性的影响。方法 选取2023年9月—2024年1月收治的择期行胃肠镜检查的老年患者90例,采用抽签法将其分为复合组和丙泊酚组、依托咪酯组3组各30例。丙泊酚组和依托咪酯组分别予丙泊酚和依托咪酯麻醉,复合组予丙泊酚复合依托咪酯混合液麻醉。比较3组麻醉效果、围检查期不良反应,麻醉诱导前(T0)、麻醉诱导后1 min(T1)、胃镜置入时(T2)、肠镜通过脾曲时(T3)、检查结束时(T4)血流动力学[PI、收缩压、舒张压、平均动脉压(MAP)、脉搏氧饱和度(SpO_(2))],以及T0和检查结束后1、6、24 h认知功能[简易智能精神状态检查量表(MMSE)]。结果 复合组和丙泊酚组麻醉诱导时间、苏醒时间、复苏室停留时间和定向力恢复时间短于依托咪酯组;T1~T4时,3组PI、收缩压、舒张压、MAP和SpO_(2)均较T0时有不同程度降低,但复合组和依托咪酯组波动幅度小于丙泊酚组(P<0.05)。T0和检查结束后1、6、24 h, 3组组间和组内MMSE评分比较差异无统计学意义(P>0.05)。围检查期,复合组和依托咪酯组注射痛、呼吸抑制发生率低于丙泊酚组,复合组和丙泊酚组肌颤发生率低于依托咪酯组(P<0.05)。结论 丙泊酚复合依托咪酯用于老年胃肠镜检查麻醉效果显著,有利于维持血流动力学稳定,且安全性较高。

Objective To investigate the effect of Propofol combined with Etomidate for sedation on gastroenteroscopy in the elderly under pulse perfusion index(PI)monitoring.Methods A total of 90 elderly inpatients who underwent gastroenteroscopy from September 2023 to January 2024 were selected as the research subjects.They were divided into three groups,combination group(n=30),Propofol group(n=30)and Etomidate group(n=30),using a random lottery method.Propofol group and Etomidate group received Propofol and Etomidate respectively for sedation,and combination group received a mixture of Propofol and Etomidate for sedation.Anesthesia effects and adverse reactions during examination,as well as the hemodynamic parameters[PI,Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),pulse oxygen saturation(SpO_(2))]before induction(T0),at 1 min after induction(T1),during gastroscopy(T2),at the time when the endoscope passed through the splenic flexture(T3),and at the end of the examination(T4)and cognitive function[mini-mental state examination(MMSE)]at T0 and at 1,6,and 24 h after completion of examination were compared among the three groups.Results The duration of anesthesia induction,time to awakening,length of resuscitation room stay,and time to orientation recovery of combination group and Propofol group were shorter than those of Etomidate group;at T1 to T4,the PI,SBP,DBP,MAP and SpO 2 of the three groups decreased to different degrees compared with those at T0,but the magnitude of fluctuation of combination group and Etomidate group was smaller than that of Propofol group(P<0.05).At T0,1 h,6 h and 24 h after the end of the examination,there was no significant intragroup and intergroup difference in the MMSE scores in the three groups(P>0.05).During examination,the incidence of injection pain and respiratory depression in combination group and Etomidate group was lower than that of Propofol group,and the incidence of myoclonic convulsions in combination group and Propofol group was lower than that of Etomidate group(P<0.05).Conclusion Propofol combined with Etomidate for sedation is effective in assisting gastroenteroscopy in the elderly,which facilitates the maintenance of hemodynamic stability with good safety.