亚麻醉剂量艾司氯胺酮复合丙泊酚用于老年患者无痛胃肠镜联合镜检的疗效观察

Efficacy of subanesthetic dose of esketamine combined with propofol in elderly patients undergoing painless gastrointestinal endoscopy

目的观察亚麻醉剂量艾司氯胺酮复合丙泊酚用于老年患者无痛胃肠镜联合镜检的疗效。方法选取择期行无痛胃肠镜联合镜检的老年患者245例,按随机数字表法分为两组:芬太尼复合丙泊酚组(F组,121例)和亚麻醉剂量艾司氯胺酮复合丙泊酚组(S组,124例)。F组静脉注射芬太尼0.8μg/kg,S组静脉注射艾司氯胺酮0.15 mg/kg,随后两组均给予丙泊酚1.5 mg/kg,采用静脉泵注丙泊酚5 mg·kg^(−1)·h^(−1)维持镇静。记录两组患者内镜检查时间、丙泊酚用量、苏醒时间、患者满意度。记录两组患者麻醉开始前(T_(0))、麻醉诱导后1 min(T_(1))、胃镜入喉时(T_(2))、肠镜入肛时(T_(3))、内镜检查结束时(T_(4))的心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2))。记录两组患者内镜检查期间低血压、呼吸抑制、心动过缓、呛咳、体动、恶心呕吐、眩晕、谵妄等不良反应发生情况。结果两组患者内镜检查时间、丙泊酚用量、苏醒时间、患者满意度差异无统计学意义(均P>0.05)。S组T_(1)、T_(2)时的心率,T_(1)~T_(4)时的MAP,T_(1)时的SpO_(2)高于F组(均P<0.05),低血压、呼吸抑制、体动的发生率低于F组(均P<0.05)。其余指标差异无统计学意义(均P>0.05)。结论亚麻醉剂量艾司氯胺酮复合丙泊酚用于老年患者无痛胃肠镜联合镜检,呼吸循环抑制轻、术中体动少,有利于维持老年患者术中生命体征平稳和保证胃肠镜联合镜检的顺利进行。

Objective To observe the efficacy of a subanesthetic dose of esketamine combined with propofol in elderly pa‑tients undergoing painless gastrointestinal endoscopy.Methods A total of 245 elderly patients were selected for painless gastroin‑testinal endoscopy,they were divided into two groups according to the random number table method:fentanyl combined with propofol group(group F,121 cases)and subanesthetic dose of esketamine combined with propofol group(group S,124 cases).Patients in group F received intravenous fentanyl 0.8μg/kg,while those in group S received intravenous esketamine 0.15 mg/kg,followed by propofol 1.5 mg/kg in both groups.Both groups received propofol infusion at 5 mg·kg^(−1)·h^(−1)to maintain sedation.Endoscopy time,total propofol dose,awakening time,and patient satisfaction were recorded in the two groups.Heart rate,mean arterial pressure(MAP),and oxygen saturation(SpO_(2))at different time points(T_(0):before anesthesia induction;T_(1):1 min after anesthesia induction;T_(2):the gastroscope enters the esophagus;T_(3):the colonoscope enters the anus;and T_(4):the end of endoscopic examination)were also recorded in the two groups.Adverse reactions such as hypotension,respiratory depression,bradycardia,coughing,agitation,nausea and vomiting,vertigo,and delirium were recorded in the two groups during endoscopy.Results There were no significant differences between the two groups in terms of endoscopy time,propofol dose,awakening time,and patient satisfaction(all P>0.05).At time points T_(1)and T_(2),the heart rate in group S was higher than in group F(all P<0.05).At time points T_(1)‒T_(4),the MAP in group S was higher than in group F(all P<0.05).At time point T_(1),the SpO_(2)in group S was higher than in group F(all P<0.05).The incidence of hypotension,respiratory depression,and agitation in group S were lower than those in group F(all P<0.05).There was no statistical significance in other indexes(all P>0.05).Conclusions The use of a subanesthetic dose of esketamine combined with propofol in elderly patients undergoing painless gastrointestinal endoscopy results in less respiratory and circulatory depression,and minimal intraoperative agitation,which is beneficial for maintaining stable vital signs during the procedure and ensures the smooth progress of the gastrointestinal endoscopy for elderly patients.