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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
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| 篇名： | 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 |
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| 摘要： | 目的：探讨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。方法：90例行无痛胃肠镜检查的老年患者随机分为丙泊酚组（30例）、依托咪酯组（30例）和联合组（30例）。丙泊酚组患者给予芬太尼注射液1 μg/kg+丙泊酚注射液1.5 mg/kg；依托咪酯组患者给予芬太尼注射液1 μg/kg+依托咪酯注射液 0.3 mg/kg；联合组患者给予芬太尼注射液1 μg/kg+丙泊酚注射液1 mg/kg+依托咪酯注射液0.15 mg/kg。观察3组患者不同时间点的收缩压（SBP）、舒张压（DBP）、心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2），检查、麻醉诱导、苏醒和定向力恢复时间，神经行为认知状态检查（NCSE）情况，不同时间点的简易精神状态检查表（MMSE）评分及不良反应发生情况。结果：丙泊酚组患者检查时SBP、DBP、MAP、SpO2均显著低于同组麻醉前、检查后及联合组，差异均有统计学意义（P＜0.05），但丙泊酚组检查后与同组麻醉前比较，差异均无统计学意义（P＞0.05）。联合组患者苏醒、定向力恢复时间均显著短于丙泊酚组和依托咪酯组，差异均有统计学意义（P＜0.05），但依托咪酯组与丙泊酚组间比较，差异均无统计学意义（P＞0.05）。联合组患者记忆能力、计算能力、定向力检查通过例数占比均显著高于丙泊酚组，差异均有统计学意义（P＜0.05），但联合组与依托咪酯组、依托咪酯组与丙泊酚组间比较，差异均无统计学意义（P＞0.05）。联合组患者不同时间点的MMSE评分比较，差异无统计学意义（P＞0.05）；丙泊酚组患者麻醉后15、30 min及依托咪酯组患者麻醉后15 min MMSE评分均显著低于同组麻醉前及联合组，差异均有统计学意义（P＜0.05），但丙泊酚组麻醉后1 h、依托咪酯组麻醉后30 min及1 h与同组麻醉前比较，差异均无统计学意义（P＞0.05）。呼吸暂停、低血压、注射痛发生率联合组、依托咪酯组＜丙泊酚组，体动反应、肌阵挛、恶心呕吐发生率联合组、丙泊酚组＜依托咪酯组，心动过缓发生率联合组＜丙泊酚组，差异均有统计学意义（P＜0.05）。结论：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较好，可减少检查后认知功能障碍，缩短苏醒时间，且未增加不良反应的发生。 |
| ABSTRACT： | OBJECTIVE： To investigate the effects of etomidate combined with propofol on painless gastrointestinal endoscopy and cognitive function of elderly patients. METHODS： Totally 90 elderly patients with painless gastrointestinal endoscopy were randomly divided into propofol group （30 cases）， etomidate group （30 cases） and combination group （30 cases）. Propofol group was given Fentanyl injection 1 μg/kg+Propofol injection 1.5 mg/kg； etomidate group was given Fentanyl injection 1 μg/kg+Etomidate injection 0.3 mg/kg； combination group was given Fentanyl injection 1 μg/kg+Propofol injection 1 mg/kg+Etomidate injection 0.15 mg/kg. The levels of SBP， DBP， HR， MAP and SpO2 at different time points， examination time， anesthesia induction time， recovery time and recovery time of orientation were observed in 3 groups. NCSE and MMSE score at different time points， the occurrence of ADR were also observed in 3 groups. RESULTS： During examination， SBP， DBP， MAP and SpO2 of propofol group were significantly lower than before anesthesia， after examination and those of combination group， with statistical significance（P＜0.05）； but there was no statistical significance in above indexes of propofol group between during examination and before anesthesia（P＞0.05）. The recovery time and recovery time of orientation in combination group were significantly shorter than propofol group and etomidate group， with statistical significance （P＜0.05）， but there was no statistical significance in above indexes between etomidate group and propofol group （P＞0.05）. The proportion of patients’ memory ability， computing ability， orientation ability passing examination in combination group were significantly higher than propofol group， with statistical significance （P＜0.05）. There was no statistical significance in above indexes between combination group and etomidate group， between etomidate group and propofol group （P＞0.05）. There was no statistical significance in MMSE score of combination group at different time points（P＞0.05）； MMSE score of propofol group 15， 30 min after anesthesia and that of etomidate group 15 min after anesthesia were significantly lower before anesthesia and combination group， with statistical significance （P＜0.05）. There was no statistical significance in MMSE score of propofol group 1 h after anesthesia， etomidate group 30 min and 1 h after anesthesia， compared to before anesthesia （P＞0.05）. The incidence of apnea， hypotension and injection pain in combination group and etomidate group were lower than propofol group， the motor response， myoclonus， nausea and vomiting in combination group and propofol group were lower than etomidate group， the tachycardia ease in combination group was lower than propofol group， with statistical significance（P＜0.05）. CONCLUSIONS： Etomidate combined with propofol anesthesia shows good therapeutic efficacy for painless gastrointestinal endoscopy of elderly patient， can reduce cognitive dysfunction and shortens recovery time， but doesn’t increase the occurrence of ADR. |
| 期刊： | 2017年第28卷第15期 |
| 作者： | 刘兴建，任和 |
| AUTHORS： | LIU Xingjian，REN He |
| 关键字： | 依托咪酯；丙泊酚；无痛胃肠镜检查；麻醉效果；认知功能 |
| KEYWORDS： | Etomidate； Propofol； Painless gastrointestinal endoscopy； Anesthesia effect； Cognitive function |
| 阅读数： | 396 次 |
| 本月下载数： | 5 次 |
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