地佐辛联合丙泊酚对老年患者无痛结肠镜检查中血流动力学及认知功能的影响

Effect of dezocine combined with propofol of elderly patients undergoing painless colonoscopy on hemodynamics and cognitive function

摘要:

目的 探讨地佐辛联合丙泊酚对老年患者无痛结肠镜检查中认知功能及血流动力学的影响。方法 选取2019年8月－2021年8月该院拟行无痛结肠镜手术的老年患者110例，用随机数表法分为单药组（丙泊酚组，n = 55）和联合用药组（地佐辛联合丙泊酚组，n = 55）。单药组静脉泵注1.5 mg/kg丙泊酚，联合用药组先静脉泵注50 μg/mL地佐辛，3 min后再静脉泵注1.5 mg/kg丙泊酚，待睫毛反射消失、全身放松后行结肠镜手术。比较两组患者给药前（T₁）、术中（T₂）和苏醒时（T₃）心率（HR）、经皮动脉血氧饱和度（SpO₂）、平均动脉压（MAP）和心脏指数（CI）；丙泊酚用量、睁眼时间、手术时间、苏醒后5、10、30和60 min视觉模拟评分法（VAS）；给药前、术后清醒时简易精神状态检查量表（MMSE）评分和血清中枢神经特异性蛋白（S100-β）浓度；术中及术后1 h不良反应发生率。结果 T₂与T₃时点联合用药组HR、SpO₂和CI均高于单药组（P < 0.05）；两组患者HR、SpO₂、MAP和CI在T₂时点均低于T₁时点，T₃时点高于T₂时点（P < 0.05）；两组患者HR及单药组CI在T₃时点低于T₁时点（P < 0.05）。联合用药组丙泊酚用量少于单药组，睁眼时间短于单药组（P < 0.05），术后10、30和60 min VAS均低于单药组（P < 0.05）。MMSE评分方面，两组患者术后1 h均低于给药前（P < 0.05），术后1 d与给药前比较，差异无统计学意义（P > 0.05）；联合用药组术后1 h高于单药组（P < 0.05），术后1 d两组间比较，差异无统计学意义（P > 0.05）。血清S100-β方面，两组患者术后1 h和术后1 d均高于给药前，术后1 d低于术后1 h（P < 0.05）；联合用药组术后1 h和术后1 d均低于单药组（P < 0.05）。联合用药组不良反应总发生率低于单药组（P < 0.05）。结论 地佐辛联合丙泊酚可减少丙泊酚用量，减少无痛结肠镜检查中对老年患者认知功能及血流动力学的影响，安全性高。

Abstract:

Objective To analyze the effect of dezocine combined with propofol of elderly patients underwent painless colonoscopy on hemodynamics and cognitive.Methods 110 elderly patients who planned to perform painless colonoscopy from August 2019 to August 2021 were divided into single drug group (propofol group, n = 55) and combination drug group (dezocine combined with propofol group, n = 55) by random number table method. The single drug group was intravenously pumped with 1.5 mg/kg propofol, and the combination drug group was intravenously pumped with 50 μg/mL dexocine, and then intravenously pumped with 1.5 mg/kg propofol 3 min later. Colonoscopy was performed after the eyelash reflex disappeared and the whole body relaxed. Heart rate (HR), percutaneous arterial oxygen saturation (SpO₂), mean arterial pressure (MAP) and cardiac index (CI) before administration (T₁), during operation (T₂) and at awakening (T₃); The dosage of propofol, eye-opening time, operation time, visual analogue scale (VAS) at 5, 10, 30 and 60 min after awakening; Score of mini mental status examination (MMSE) and central nervous specific protein (S100-β) in serum before and after administration; The adverse reactions incidence rate during and 1 h after operation were compared.Results HR, SpO₂ and CI in T₂ and T₃ combined drug group were higher than those in single drug group (P < 0.05). HR, SpO₂, MAP and CI of the two groups were lower at T₂ than T₁, and higher at T₃ than T₂ (P < 0.05). HR of two groups and CI of single drug group were lower at T₃ time point than at T₁ time point (P < 0.05). The dosage of propofol of combination drug group was less than that of single drug group, and eye opening time of the combination drug group was less than that of the single drug group (P < 0.05), and the VAS 10 min, 30 min, 60 min after surgery were lower than those in the single drug group (P < 0.05). In terms of MMSE score, 1 hour after operation was lower than that before administration (P < 0.05), and there was no statistical difference between the two groups 1 day after operation and before administration (P > 0.05), the combination drug group was higher than the single treatment group 1 hour after surgery (P < 0.05), and there was no statistical difference between the two groups 1 day after surgery (P > 0.05). In terms of serum S100-β, 1 hour and 1 day after operation were higher than before administration, and 1 d after operation was lower than 1 hour after operation (P < 0.05). The combination drug group was lower than the single drug group 1 hour and 1 day after surgery (P < 0.05). The total incidence of adverse reaction within 1 h after operation of the combination drug group was lower than that of the single drug group (P < 0.05).Conclusion Dezocine combined with propofol can reduce the dosage of propofol, reduce the impact of painless colonoscopy on the cognitive function and hemodynamics of elderly patients, and has high safety.