Clinical comparison of different drugs combined with anesthesia for painless gastroscopy in elderly patients
-
摘要:
目的对比不同药物配伍麻醉用于老年患者无痛胃镜检查的临床效果及安全性。 方法将160例拟行无痛胃镜检查的老年患者通过随机数字表法分为RP组(瑞芬太尼+异丙酚+利多卡因)和DRE组(地佐辛+瑞芬太尼+依托咪酯),每组80例。其中RP组男44例,女36例,年龄65.48±5.98岁;DRE组男40例,女40例,年龄66.19±5.13岁。比较两组胃镜置入时间、胃镜检查时间、患者苏醒时间和患者离院时间。观察两组胃镜检查前(T0)、胃镜检查中(T1)和胃镜检查后(T2)的收缩压、舒张压、心率、呼吸频率和血氧饱和度。于T0、T2检测两组血浆C反应蛋白及皮质醇、去甲肾上腺素浓度水平。比较两组麻醉效果及不良反应。记录操作者满意度、麻醉医师满意度及患者舒适度。 结果两组患者胃镜置入时间、胃镜检查时间、患者苏醒时间和患者离院时间差异无统计学意义(P>0.05);两组T0时收缩压、舒张压、心率、呼吸频率、血氧饱和度差异无统计学意义(P>0.05),T1、T2时RP组收缩压、舒张压低于DRE组(P < 0.05),T2时心率低于DRE组(P < 0.05),T1时血氧饱和度低于DRE组(P < 0.05)。与T0时比较,两组T2时C反应蛋白皮质醇、去甲肾上腺素水平增高,但DRE组增高幅度低于RP组(P < 0.05)。两组麻醉效果差异无统计学意义(P>0.05)。DRE组低血压发生率低于RP组(P < 0.05),肌颤发生率高于RP组(P < 0.05)。两组操作者满意度、患者舒适度差异无统计学意义(P>0.05),DRE组麻醉医师满意度高于RP组。 结论依托咪酯复合瑞芬太尼及小剂量地佐辛用于老年患者无痛胃镜检查,在稳定血流动力学、减轻应激反应及提升患者舒适度方面优于异丙酚复合瑞芬太尼及利多卡因。 Abstract:ObjectiveTo compare the clinical effect and safety of different drugs combined with anesthesia for painless gastroscopy in elderly patients. MethodsA total of 160 elderly patients who planned to undergo painless gastroscopy were randomly divided into RP group (remifentanil+propofol+lidocaine) and DRE group (dizocine+remifentanil+etomidate), with 80 casesin each group. RP group included 44 males and 36 females, with the average age of 65.48±5.98 years old. DRE group included 40 males and 40 females with the average age of 66.19±5.13 years old. The two groups were compared in terms of the time of endoscopic implantation, the time of gastroscopy examination, the time of patients' waking up and the time of patients' leaving hospital. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR) and blood oxygen saturation (SpO2) of the two groups before gastroscopy (T0), during gastroscopy (T1) and after gastroscopy (T2) were compared. Plasma C-reactive protein (CRP), cortisol (Cor) and norepinephrine (NE) levels were measured before (T0) and after (T2) gastroscopy. The anaesthesia effect and adverse reactions during and after operation were compared between the two groups. Operator satisfaction, anesthesiologist satisfaction, and patient comfort were recorded. ResultsThere were no significant differences in the time of endoscopic implantation, time of gastroscopy, time of patient awakening and time of patient leaving hospital between the two groups (P>0.05). SBP and DBP in RP group were lower than RE group at T1 and T2 (P < 0.05). HR at T2 was lower than RE group (P < 0.05). SpO2 at T1 was lower than RE group (P < 0.05). Compared with T0, CRP Cor and NE levels increased in the two groups at T2, but the increase in DRE group was lower than that in RP group (P < 0.05). There was no significant difference in anesthetic effect between the two groups (P>0.05). No serious adverse reactions such as laryngospasm and allergy occurred in the two groups. The incidence of hypotension in DRE group was lower than that in RP group (P < 0.05). The incidence of muscle fibrillation was higher than that in RP group (P < 0.05). There was no significant difference in operator satisfaction and patient comfort between the two groups (P>0.05). The satisfaction of anesthesiologists in DRE group was higher than that in RP group(P < 0.05). ConclusionEtomidate combined with remifentanil and low-dose dizocine are used for painless gastroscopy in elderly patients, which is better than propofol combined with remifentanil and lidocaine in stabilizing hemodynamics, reducing stress response and improving patient comfort. -
Key words:
- gastroscope /
- anesthesia /
- old patient /
- etomidate /
- remifentanil /
- dizocine /
- propofol /
- lidocaine /
- dose administered /
- security
-
表 1 两组基线资料对比(n=80, Mean±SD)
Table 1. Comparison of baseline data between the two groups
组别 年龄(岁) 性别(男/女) BMI(kg/m2) ASA分级 Mallampati分级 RP组 65.48±5.98 44/36 22.97±3.35 1.62±0.15 1.35±0.12 DRE组 66.19±5.13 40/40 23.08±3.56 1.72±0.18 1.39±0.13 RP组:瑞芬太尼+异丙酚+利多卡因; DRE组:地佐辛+瑞芬太尼+依托咪酯; BMI: Body mass index; ASA: American Society ofAnesthesiologists. 表 2 2组胃镜置入时间、胃镜检查时间、患者苏醒时间和患者离院时间比较(n=80, Mean±SD)
Table 2. Comparison of endoscopy implantation time, gastroscopy time, patient recovery time and patient departure time between the two groups
组别 胃镜置入时间(s) 胃镜检查时间(s) 患者苏醒时间(s) 患者离院时间(s) RP组 65.46±20.83 288.69±97.81 419.80±138.71 1081.45±176.39 DRE组 68.35±18.67 285.30±95.06 423.95±140.83 1093.64±180.20 表 3 两组生命体征指标比较(n=80, Mean±SD)
Table 3. Comparison of vital signs between the two groups
指标 组别 T0 T1 T2 SBP (mmHg) RP组 116.49±19.04 94.93±18.33a 95.73±16.45a DRE组 116.58±18.87 07.65±21.76 16.17±20.87 DBP (mmHg) RP组 67.96±10.75 56.39±13.40a 59.33±14.05a DRE组 70.08±12.08 68.18±16.79 71.60±18.64 HR (次/min) RP组 73.89±12.91 74.95±12.63 71.84±11.07a DRE组 74.06±13.11 75.20±13.27 75.98±13.30 RR (次/min) RP组 17.89±3.18 16.92±4.13 16.78±3.59 DRE组 17.06±3.64 15.63±3.60 15.06±3.28 SpO2(%) RP组 97.98±1.91 94.64±2.60a 98.35±1.61 DRE组 97.72±1.63 97.30±2.39 98.50±1.59 aP < 0.05 vs DRE组; SBP: Systolic Blood Pressure; DBP: Diastolic Blood Pressure; HR: Heart Rate; RR: Respiratory Rate. 表 4 两组患者T0、T4时Cor、NA血浆水平比较(n=80, Mean±SD)
Table 4. Comparison of Cor and NAplasma levels at T0 and T4 in the two groups
组别 CRP (mg/L) Cor (ng/mL) NE (ng/L) T0 T2 T0 T2 T0 T2 RP组 5.34±0.58 7.59±0.76a 178.63±16.81 219.71±18.20a 173.62±29.21 359.85±49.03a DRE组 5.38±0.59 6.30±0.63ab 179.50±16.93 197.32±17.86ab 171.39±29.65 317.97±48.19ab aP < 0.05 vs本组T0; bP < 0.05 vs RP组同时间点; CRP: C-Reactive Protein; Cor: Cortisol; NE: Norepinephrine. 表 5 2组麻醉效果及不良反应对比[n=80, n(%)]
Table 5. Comparison of anesthetic effect and adverse reactions in the two groups
组别 麻醉效果 低血压 心动过缓 低氧血症 体动反应 注射痛 肌颤 恶心呕吐 Ⅰ级 Ⅱ级 Ⅲ级 RP组 43(53.75) 33(41.25) 4(5.00) 5(6.25) 7(8.75) 4(5.00) 4(5.00) 2(2.50) 1(1.25) 1(1.25) DRE组 40(50.00) 35(43.75) 5(6.25) 1(1.25)a 8(10.00) 2(2.50) 6 (7.50) 1(1.25) 5(6.25)a 1(1.25) aP < 0.05 vs RP组. 表 6 两组患者操作者满意度、麻醉医师满意度及患者舒适度比较[n=80, n(%)]
Table 6. Comparison of operator satisfaction, anesthesiologist satisfaction and patient comfort between the two groups
组别 操作者满意度 麻醉医师满意度 患者舒适度 优良 一般 较差 优良 一般 较差 优良 一般 较差 RP组 66 (82.50) 10 (12.50) 4 (5.00) 49(61.25) 15(18.75) 16(20.00) 60(75.00) 17(21.25) 3(3.75) DRE组 63 (78.75) 11 (13.75) 6 (7.50) 58(72.50)a 17(21.25) 5(6.25) 62(77.50) 16(20.00) 2(2.50) aP < 0.05 vs RP组. -
[1] Travis AC, Pievsky D, Saltzman JR. Endoscopy in the elderly[J]. Am J Gastroenterol, 2012, 107(10): 1495-501. doi: 10.1038/ajg.2012.246 [2] 李莉, 谭跃, 黎振林, 等.老年人无痛胃镜常见的并发症及其防治[J].中国老年学杂志, 2013, 33(9): 2191-2. doi: 10.3969/j.issn.1005-9202.2013.09.109 [3] 王芬, 沈守荣, 欧阳文, 等.老年人实施镇静性上消化道内镜术的特点[J].中华老年医学杂志, 2007, 26(11): 813-5. http://d.old.wanfangdata.com.cn/Periodical/zhlnyx200711002 [4] 夏江燕, 陆新健, 袁静, 等.丙泊酚复合阿片类药物在胃镜检查中的应用[J].临床麻醉学杂志, 2016, 32(5): 464-7. http://d.old.wanfangdata.com.cn/Periodical/lcmzxzz201605015 [5] 赵银洁, 王伍超, 陈扬, 等.阿片类镇痛药复合异丙酚在无痛胃镜检查麻醉中的应用比较[J].国际麻醉学与复苏杂志, 2012, 33(8): 513-6. doi: 10.3760/cma.j.issn.1673-4378.2012.08.003 [6] 郑丰平, 黎嘉妍, 郭云蔚, 等.丙泊酚联合芬太尼作为肝硬化患者无痛胃镜检查镇静剂的临床效果观察[J].中华消化内镜杂志, 2012, 29 (6): 311-5. doi: 10.3760/cma.j.issn.1007-5232.2012.06.005 [7] Na YC, Lee HG, Lee SH, et al. The efficacy of sevolflurane inhalation alone or its combination with intravenous remifentanil against withdrawal movements on rocuronium injection in children[J]. Korean JAnesthesiol, 2014, 67(6): 373-7. doi: 10.4097/kjae.2014.67.6.373 [8] Zhang LF, Bao Y, Shi DP. Comparing the pain of propofol via different combinations of fentanyl, sufentanil or remifentanil in gastrointestinal endoscopy[J].Acta Cir Bras, 2014, 29(10): 675-80. doi: 10.1590/S0102-8650201400160008 [9] 刘恋, 夏中元, 陈榕, 等.靶控输注依托咪酯和异丙酚对全麻患者肾上腺皮质功能影响及不良反应的系统评价[J].疑难病杂志, 2016, 15 (10): 1069-73. doi: 10.3969/j.issn.1671-6450.2016.10.020 [10] 中华医学会麻醉学分会, 中华医学会消化内镜学分会.中国消化内镜诊疗镇静/麻醉的专家共识[J].临床麻醉学杂志, 2014, 30(9): 920-7. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcmzxzz201409027 [11] Liu RY, Huang XP, Yeliseev A, et al. Novel molecular targets of dezocine and their clinical implications[J]. Anesthesiology, 2014, 120(3): 714-23. doi: 10.1097/ALN.0000000000000076 [12] 杨敏.两种麻醉方案在行无痛胃镜老年患者中的效果比较[J].西南国防医药, 2018, 28(6): 540-2. doi: 10.3969/j.issn.1004-0188.2018.06.014 [13] 陆希, 何农, 朴哲, 等.老年患者无痛胃肠镜检查麻醉药物使用分析[J].中国公共卫生, 2017, 33(4): 656-7. http://d.old.wanfangdata.com.cn/Periodical/zgggws201704035 [14] 肖兴鹏, 李思琦, 王颖, 等.丙泊酚复合地佐辛麻醉对胃镜检查患者心理焦虑及舒适度的影响[J].中国医院用药评价与分析, 2020, 20 (1): 37-9. http://d.old.wanfangdata.com.cn/Periodical/zgyyyypjyfx202001009 [15] 张浩, 刘存明.瑞芬太尼靶控输注在过度肥胖患者无痛胃镜检查中的应用[J].医学研究杂志, 2017, 46(4): 154-6. http://d.old.wanfangdata.com.cn/Periodical/yxyjtx201704039 [16] 蒋远洪, 谭友果.无痛胃镜在不同人群中的应用进展[J].中国内镜杂志, 2015, 21(2): 163-5. http://d.old.wanfangdata.com.cn/Periodical/zgnjzz201502013 [17] Leslie K, Allen ML, Hessian E, et al. Survey of anaesthetists' practice of sedation for gastrointestinal endoscopy[J]. Anaesth Intensive Care, 2016, 44(4): 491-7. doi: 10.1177/0310057X1604400409 [18] 王莉, 李雯, 徐锐, 等.依托咪酯和异丙酚对无痛人工流产术麻醉效果和不良反应的Meta分析[J].中南大学学报:医学版, 2016, 41 (4): 427-33. http://d.old.wanfangdata.com.cn/Periodical/hnykdx201604015 [19] 曾彦茹, 佘守章, 黄宇光.阿片类药物地佐辛临床应用研究现状[J].广东医学, 2018, 39(1): 6-9. http://d.old.wanfangdata.com.cn/Periodical/gdyx201801002 [20] 郭波, 汤伟.异丙酚和依托咪酯复合瑞芬太尼对老年无痛胃镜患者的呼吸循环系统影响的比较[J].重庆医学, 2017, 46(5): 628-31. doi: 10.3969/j.issn.1671-8348.2017.05.017 [21] Shen XC, Ao X, Cao Y, et al. Etomidate-remifentanil is more suitable for monitored anesthesia care during gastroscopy in older patients than propofol-remifentanil[J]. Med Sci Monit, 2015, 21: 1-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4288392/ [22] Xu BB, Zhao XL, Xu GP. Clinical study of anesthetization by dezocine combined with propofol for indolent colonoscopy[J]. World J Gastroenterol, 2016, 22(24): 5609-15. doi: 10.3748/wjg.v22.i24.5609 [23] 郑晖.地佐辛或芬太尼联合丙泊酚在结肠镜肠息肉切除术中的麻醉效果和安全性[J].中国医药, 2017, 12(9): 1382-5. doi: 10.3760/cma.j.issn.1673-4777.2017.09.027 [24] 刘兴建, 任和.依托咪酯联合丙泊酚用于老年患者无痛胃肠镜检查的麻醉效果及对患者认知功能的影响[J].中国药房, 2017, 28(15): 2028-32. doi: 10.6039/j.issn.1001-0408.2017.15.04 [25] Kizilcik N, Menda F, Bilgen S, et al. Effects of a fentanyl-propofol mixture on propofol injection pain: a randomized clinical trial[J]. Korean JAnesthesiol, 2015, 68(6): 556-60. doi: 10.4097/kjae.2015.68.6.556 [26] 朱琼, 郑吉卫, 朱朋朋.依托咪酯-异丙酚混合液在老年人无痛胃镜的应用[J].中国药物与临床, 2015, 15(8): 1162-4. http://d.old.wanfangdata.com.cn/Periodical/zgywylc201508056
计量
- 文章访问数: 721
- HTML全文浏览量: 244
- PDF下载量: 6
- 被引次数: 0