格隆溴铵对无痛肠镜中肠痉挛和血流动力学的影响

The effect of glycopyrrolate on intestinal spasm and hemodynamics in painless colonoscopy

目的探讨格隆溴铵对患者接受无痛肠镜中肠痉挛和血流动力学的影响。方法选择温州医科大学附属金华医院(金华市人民医院)2022年3月至2023年12月100例拟行无痛肠镜检查的患者作为研究对象,采用计算机随机数字法分为2组,试验组患者在麻醉前注射0.2 mg格隆溴铵,对照组患者在麻醉前注射等量生理盐水。两组中共有10例患者因研究方案中断而退出,每组各45例患者纳入分析。记录患者在T_(0)(基线期)、T_(1)(麻醉诱导后)、T_(2)(肠镜过乙状结肠)、T_(3)(肠镜过肝区)、T_(4)(检查结束时)、T_(5)(患者苏醒后)的心率、血压及术中去甲肾上腺素使用剂量,术中采用Likert四级评分法评估患者肠痉挛程度,术前术后采用数字模拟评分量表(NRS)用于评估疼痛情况,记录两组不良事件的发生率及进镜时间、腺瘤发现率和结肠镜并发症等。结果两组患者基线期一般数据差异无统计学意义(均P>0.05)。试验组患者术中低血压、心动过缓发生率低于对照组患者(P<0.05),术中去甲肾上腺素使用剂量低于对照组患者(P=0.034)。试验组患者术中肠痉挛评分更低(P=0.028)。术后试验组患者NRS疼痛评分更低(P=0.047),但试验组患者术后发生口干比例更高(P=0.035)。两组进镜时间、腺瘤发现率差异无统计学意义,均未发生结肠镜并发症。结论在无痛肠镜检查过程中,术前给予格隆溴铵可显著改善术中血流动力学波动,减少术中低血压和心动过缓的发生率,缓解肠道痉挛导致的术后疼痛,但有口干的风险。

Objective To investigate the effects of glycopyrrolate on intestinal spasm and hemodynamics in painless colonoscopy.Methods A total of 100 patients who were scheduled to undergo painless colonoscopy were selected as the study subjects and randomly divided into two groups by a computerized number method.Ten patients in both groups dropped out because of disruption of the study protocol,and 45 patients from each group were included in the final analysis.Before anesthesia induction,patients in group glycopyrrolate(group G)were injected with 0.2 mg glycopyrrolate,while those in congtrol group(group C)were injected with an equal amount of saline.The heart rate,systolic blood pressure,and diastolic blood pressure were recorded at T_(0)(baseline period),T_(1)(after anesthesia induction),T_(2)(colonoscopy over sigmoid colon),T_(3)(colonoscopy over the liver region),T_(4)(after the end of examination),and T_(5)(at the awakening phase),and the degree of intestinal spasm was assessed intraoperatively using the Likert′s four-point scale.The numerical rating scale(NRS)was used to assess preoperative and postoperative pain.The incidence of adverse events was recorded.Results The general data at baseline were not statistically different between the two groups(P>0.05).During the procedure,patients in group G had lower intraoperative intestinal spasm scores than those in group C(P=0.028).Intraoperative hypotension and bradycardia occurrence were lower in group G than in group C(P<0.05),and intraoperative norepinephrine use was also lower than in the group C(P=0.034).Postoperative visual analog scale pain scores were lower in group G(P=0.047),but patients who used glycopyrrolate had a higher proportion of dry mouth(P=0.035).Conclusion During painless colonoscopy,preoperative administration of glycopyrrolate significantly improved intraoperative hemodynamic fluctuations,reduced the incidence of hypotension and bradycardia,and relieved postoperative pain.However,glycopyrrolate use resulted in the risk of dry mouth.