纳布啡复合丙泊酚麻醉在老年患者无痛胃镜检查中的应用及对患者认知功能的影响

Application of Nalbuphine combined with Propofol anesthesia in elderly patients undergoing painless gastroscopy and its influence on cognitive function

摘要:

目的 观察纳布啡复合丙泊酚在老年患者无痛胃镜检查中的麻醉效果及对患者认知功能的影响，探讨纳布啡复合丙泊酚的合适剂量范围。方法 选择该院2018年2月－2020年1月156例行无痛胃镜检查的老年患者作为研究对象。将患者分为低剂量纳布啡+丙泊酚组（LNP）、中剂量纳布啡+丙泊酚组（MNP）、高剂量纳布啡+丙泊酚组（HNP），每组52例。比较3组患者丙泊酚追加剂量、手术时间、苏醒时间、简易精神状态检查量表（MMSE）评分、不良反应发生情况和麻醉优良率，采用ELISA法检测肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）。结果 3组患者手术时间比较，差异无统计学意义（P > 0.05）。MNP组和HNP组丙泊酚追加剂量明显少于LNP组，苏醒时间明显短于LNP组（P < 0.01），MNP组和HNP组间丙泊酚追加剂量和苏醒时间比较，差异无统计学意义（P > 0.05）。MNP组和HNP组麻醉优良率分别为94.2%和96.2%，明显高于LNP组的80.8%（P < 0.05），MNP组和HNP组间麻醉优良率比较，差异无统计学意义（P > 0.05）。3组患者检查前TNF-α和IL-6表达比较，差异无统计学意义（P > 0.05）。患者苏醒30 min后，MNP组和HNP组TNF-α和IL-6表达明显低于LNP组（P < 0.01），MNP组和HNP组间比较，差异无统计学意义（P > 0.05）。3组患者麻醉前MMSE评分比较，差异无统计学意义（P > 0.05），麻醉24 h后，MNP组和HNP组MMSE评分明显高于LNP组（P < 0.01），MNP组和HNP组间比较，差异无统计学意义（P > 0.05）。LNP组和MNP组离院时眩晕发生率明显低于HNP组（P < 0.05），LNP组和MNP组间比较，差异无统计学意义（P > 0.05）。结论 老年患者无痛胃镜检查中MNP可以获得较好的麻醉效果，对患者认知功能影响小，可减轻患者炎症应激反应和不良反应。

Abstract:

Objective To observe the application of Nalbuphine combined with Propofol anesthesia in elderly patients undergoing painless gastroscopy and its influence on cognitive function, and explore the appropriate dosage selection of Nalbuphine combined with Propofol in treatment of painless gastroscopy of elder patients.Methods 156 patients underwent painless gastroscopy from February 2018 to January 2020 were enrolled in this study. Which was divided into Low dose Nalbuphine+Propofol group (LNP), middle dose Nalbuphine+Propofol group (MNP), high dose Nalbuphine+Propofol group (HNP). The additional dose of Propofol, operation time, recovery time, mini mental status examination (MMSE) scores, adverse rate and anesthesia effect in the three groups was compared. TNF-α and IL-6 was detected by ELISA.Results There was no significant difference in operation time among the three groups (P > 0.05). The additional dose of Propofol in MNP and HNP group was lower than that in LNP group, and recovery time in MNP and HNP group was shorter than that in LNP group (P < 0.01). There was no significant difference of additional dose of Propofol and recovery time between MNP and HNP group (P > 0.05). The anesthesia effect in MNP and HNP group was 94.2% and 96.2%, which was higher than that of 80.8% in LNP group (P < 0.05). There was no significant difference of anesthesia effect between MNP and HNP group (P > 0.05). There was no significant difference in TNF-α and IL-6 expression among the three groups before examination (P > 0.05). After waking up for 30 minutes, the TNF-α and IL-6 expression in MNP and HNP group was lower than that in LNP group (P < 0.01). There was no significant difference of TNF-α and IL-6 expression between MNP and HNP group (P > 0.05). There was no significant difference in MMSE scores among the three groups before anesthesia (P > 0.05). After 24 h of anesthesia, the MMSE scores in MNP and HNP group was higher than that in LNP group (P < 0.01). There was no significant difference of MMSE scores between MNP and HNP group (P > 0.05). The incidence of vertigo in LNP group and MNP group was significantly lower than that in HNP group (P < 0.05). There was no significant difference of vertigo incidence between LNP and MNP group (P > 0.05).Conclusion In elder patients with painless gastroscopy, moderate dose of Nalbuphine combined with Propofol can obtain significant anesthetic effect, and have little influence on cognitive function, which reduced inflammatory stress response and adverse reactions.