地佐辛复合氯胺酮在老年患者无痛胃镜检查中的应用

Effect of dizocine combined with ketamine on painless gastroscopy in the elderly

目的探讨地佐辛复合氯胺酮应用于老年无痛胃镜检查中的临床效果。方法选取中南大学湘雅二医院2016年10月至2017年10月需要行无痛胃镜检查的老年患者120例,按随机数字表法分为3组,每组40例。麻醉方法分别为,A组采用地佐辛0. 05 mg/kg+氯胺酮0. 05 mg/kg+丙泊酚1. 5~2. 5 mg/kg;B组采用地佐辛0. 05 mg/kg+丙泊酚1. 5~2. 5 mg/kg;C组单纯使用丙泊酚1. 5~2. 5 mg/kg。记录术前、睫毛反应消失时、术中、术后的平均动脉压(MAP)、心率及脉搏血氧饱和度(Sp O2)。记录患者术中丙泊酚用量、手术时间及清醒时间。记录术后2、4、8、12、24、48 h疼痛视觉模拟量表(VAS)评分,以及术中及术后不良反应发生情况。结果在睫毛反应消失时和术中这2个时点,A、B组患者的MAP、心率、Sp O2水平均明显高于C组(均P <0. 05)。A组患者术中丙泊酚用量明显低于B、C组[(106±19) mg比(137±19)、(182±27) mg],A、B组患者清醒时间明显短于C组[(5. 1±1. 7)、(5. 4±1. 4) min比(7. 2±2. 1) min],差异均有统计学意义(均P <0. 05)。A、B组患者在术后4、8、12 h时的VAS评分均明显低于C组[(2. 9±0. 6)、(2. 8±0. 7)分比(3. 2±0. 6)分,(2. 4±0. 5)、(2. 4±0. 6)分比(2. 9±0. 6)分,(2. 0±0. 4)、(2. 0±0. 6)分比(2. 5±0. 6)分](均P <0. 05)。3组患者体动反应、呛咳、头晕头痛、恶心呕吐的发生率差异均有统计学意义,A组体动反应、恶心呕吐的发生率明显低于B组[0比12. 5%(5/40)、0比10. 0%(4/40)](均P <0. 05)。结论地佐辛复合氯胺酮用于老年患者无痛胃镜检查安全有效。

Objective To observe the clinical effect of dezocine combined with ketamine on painless gastroscopy in elderly patients.Methods A total of 120 patients undergoing painless gastroscopy in the Second Xiangya Hospital of Central South University from October 2016 to October 2017 were randomly divided into3 groups,with 40 cases in each group.The group A had anesthesia with dezocine 0.05 mg/kg+ketamine0.05 mg/kg+propofol 1.5-2.5 mg/kg;the group B had dezocine 0.05 mg/kg+propofol 1.5-2.5 mg/kg;the group C had propofol 1.5-2.5 mg/kg alone.Mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(Sp O2)were recorded before operation,after eyelash reflex disappeared,during operation and after operation.Propofol consumption,operating time,awakening time,scores of Visual Analogue Scale(VAS)at 2,4,8,12,24,48 h after operation and the incidence of side effects were analyzed.Results MAP,HR and Sp O2 in group A and B were significantly higher than those in group C after eyelash reflex disappeared and during operation(all P<0.05).Intraoperative propofol dosage in group A was significantly less than that in group B and C[(106±19)mg vs(137±19),(182±27)mg];awakening time in group A and B was significantly shorter than that in group C[(5.1±1.7),(5.4±1.4)min vs(7.2±2.1)min](all P<0.05).At 4,8,12 h after operation,VAS scores in group A and B were significantly lower than those in group C[(2.9±0.6),(2.8±0.7)vs(3.2±0.6);(2.4±0.5),(2.4±0.6)vs(2.9±0.6);(2.0±0.4),(2.0±0.6)vs(2.5±0.6)](all P<0.05).Incidences of intraoperative motion,cough,dizziness and headache,nausea and vomiting showed significant differences among the 3 groups;the incidences of intraoperative motion,nausea and vomiting in group A were significantly lower than those in group B[0 vs 12.5%(5/40),0 vs 10.0%(4/40)](both P<0.05).Conclusion Dezocine combined with ketamine shows a good anesthesia effect and few side effects on elderly patients undergoing painless gastroscopy.