丙泊酚复合依托咪酯对行无痛胃镜检查老年患者术后认知功能的影响

Effects of Propofol Combined with Etomidate on Postoperative Cognitive Function in Elderly Patients Undergoing Painless Gastroscopy

目的:探讨丙泊酚复合依托咪酯对行无痛胃镜检查老年患者术后认知功能的影响。方法:选择在临沂市人民医院总院区2020年07月至2021年07月期间80例胃镜检查老年患者作为研究对象,年龄为65~75周岁,根据美国麻醉医师协会ASA分级为I~II级。观察组(n = 40)为丙泊酚复合依托咪酯全麻组;对照组(n = 40)为普通胃镜组。于术前由研究者对患者进行MMSE评分,并于术后3个月由研究者对患者再次进行评分,评估术后认知功能障碍(Postoperative cognitive dysfunction,简称POCD)发生率,并对两组进行比较分析。记录观察组患者手术时长、麻醉用药量、收缩压及舒张压、BIS值、脉搏氧饱和度。记录对照组患者手术时长、收缩压及舒张压、脉搏氧饱和度。对比两组患者基础资料,并比较两组患者POCD发生率。结果:无痛胃镜组随访失联3例,一例术后3个月内行冠状动脉支架植入手术,一例术后3个月内行腰椎手术,以上患者均予以排除,故实际纳入患者35例。普通胃镜组随访失联3例,实际纳入37例。两组胃镜检查组在性别、年龄、文化程度、手术时间、合并高血压和/或糖尿病等基本情况方面比较无统计学差异。差值统计法:无痛胃镜组POCD发生率(5/35,即14.29%)与普通胃镜组POCD发生率(8/37即21.62%)相比较,差异无统计学意义(P = 0.42, P 】0.05)。Z计分法:以普通胃镜检查作为对照组,无痛胃镜POCD发生率与普通胃镜POCD发生率相比无差异,即丙泊酚复合依托咪酯对老年人无痛胃镜检查同普通胃镜检查术后相比认知功能无统计学差异。结论:本文研究结果得出,丙泊酚复合依托咪酯对行无痛胃镜检查老年患者术后认知功能无明显影响。

Objective: To investigate the effect of propofol combined with etomidate on postoperative cognitive function of elderly patients undergoing painless gastroscopy. Methods: A total of 80 elderly patients who underwent gastroscopy from July 2020 to July 2021 in the General Hospital of Linyi City People’s Hospital were selected as the research subjects, aged 65~75 years old, and classified as I~II according to the American Society of Anesthesiologists ASA. The observation group (n = 40) was the propofol combined etomidate general anesthesia group;the control group (n = 40) was the normal gastroscopy group. The MMSE score was scored by the researchers before surgery, the patients were scored again 3 months after surgery to evaluate the incidence of postoperative cognitive dysfunction (POCD), and the two groups were compared and analyzed. The operation time, anesthetic dosage, systolic and diastolic blood pressure, BIS value, and pulse oxygen saturation were recorded in the observation group. The operation time, systolic and diastolic blood pressure, and pulse oxygen saturation were recorded in the control group. The basic data of the two groups of patients were compared, and the incidence of POCD was compared between the two groups. Results: In the painless gastroscopy group, 3 patients lost contact during follow-up, one patient underwent coronary stent implantation within 3 months after operation, and one patient underwent lumbar spine surgery within 3 months after operation. All the above patients were excluded, so 35 patients were actually included. In the normal gastroscopy group, 3 cases were lost during follow-up, and 37 cases were actually included. There were no statistically significant differences in gender, age, educational level, operation time, hypertension and/or diabetes mellitus between the two groups of gastroscopy groups. Difference statistic method: There was no significant difference in the incidence of POCD in the painless gastroscopy group (5/35, or 14.29%) compared with the incidence of POCD in the ordinary gastroscope group (8/37, or 21.62%) (P = 0.42, P >0.05). Z-Score Method: Taking ordinary gastroscopy as the control group, there was no difference in the incidence of POCD between painless gastroscopy and ordinary gastroscopy. There was no statistical difference in cognitive function between the two groups. Conclusion: The results of this study show that propofol combined with etomidate has no significant effect on postoperative cognitive function of elderly patients undergoing painless gastroscopy.