艾司氯胺酮复合布托啡诺在老年肥胖患者无痛胃肠镜检查中的应用研究

Application of esketamine combined with butorphanol in painless gastroenteroscopy for elderly patients with obesity

摘要:

目的 探讨艾司氯胺酮复合布托啡诺在老年肥胖患者无痛胃肠镜检查中的麻醉效果，及其对患者血流动力学的影响。方法 选取2022年1月－2024年3月于该院接受无痛胃肠镜检查的老年肥胖患者124例，随机分为观察组和对照组，各62例。两组均给予丙泊酚1.50 mg/kg麻醉诱导，观察组于丙泊酚静脉注射前给予艾司氯胺酮0.20 mg/kg复合布托啡诺10 μg/kg静脉注射，对照组于丙泊酚静脉注射前给予与艾司氯胺酮等容量的生理盐水复合布托啡诺10 μg/kg静脉注射。分别于入室时（T₀）、麻醉诱导后即刻（T₁）、胃镜置入即刻（T₂）、胃镜检查结束即刻（T₃）、肠镜置入即刻（T₄）和肠镜检查结束即刻（T₅），比较两组患者的生命体征指标［平均动脉压（MAP）、心率（HR）和经皮动脉血氧饱和度（SpO₂）］。于无痛胃肠镜检查过程中，对两组患者的麻醉效果进行评价。比较两组患者胃肠镜检查时间和丙泊酚用量等情况。分别于术后1、2、3和4 h，采用视觉模拟评分法（VAS）评分评估两组患者术后疼痛程度。统计两组患者术中和术后不良反应情况。结果 观察组T₃、T₄和T₅时点MAP明显低于T₀时点，T₄和T₅时点HR明显低于T₀时点，差异均有统计学意义（P < 0.05），组内各时点SpO₂比较，差异无统计学意义（P > 0.05）；对照组T₁、T₂、T₃、T₄和T₅时点MAP、HR和SpO₂明显低于T₀时点，差异均有统计学意义（P < 0.05）；对照组T₁、T₂、T₃、T₄和T₅时点MAP、HR和SpO₂明显低于观察组，差异均有统计学意义（P < 0.05）。观察组麻醉优良率明显高于对照组，差异有统计学意义（P < 0.05）。观察组丙泊酚用量明显少于对照组，苏醒时间明显短于对照组，差异均有统计学意义（P < 0.05）。两组患者胃肠镜检查时间、麻醉恢复室（PACU）停留时间和离院时间比较，差异均无统计学意义（P > 0.05）。观察组术后1、2、3和4 h疼痛VAS评分明显低于对照组，差异均有统计学意义（P < 0.05）。观察组呼吸抑制发生率为3.23%，明显低于对照组的19.35%，观察组低血压发生率为4.84%，明显低于对照组的25.81%，观察组心动过缓发生率为0.00%，明显低于对照组的17.74%，观察组恶心呕吐发生率为1.61%，明显低于对照组的12.90%，差异均有统计学意义（P < 0.05）；两组患者心动过速、呛咳、体动和头晕等发生率比较，差异均无统计学意义（P > 0.05）。结论 艾司氯胺酮复合布托啡诺用于老年肥胖患者无痛胃肠镜检查，能有效地提高镇静和镇痛作用，减轻血流动力学的异常波动，降低不良反应发生率。值得临床推广应用。

Abstract:

Objective To explore the effect of esketamine combined with butorphanol on hemodynamics in painless gastroenteroscopy for elderly patients with obesity and the anesthetic efficacy and safety of this combined anesthesia regimen.Methods The subjects of this study, 124 elderly patients with obesity who received painless gastroenteroscopy from January 2022 to March 2024, were randomly divided into two groups, each with 62 cases. Both groups were administrated with propofol 1.50 mg/kg for anesthesia induction. The observation group was given esketamine 0.20 mg/kg combined with butorphanol 10 μg/kg intravenously prior to propofol injection, while the control group was given saline of the same volume as esketamine combined with butorphanol 10 μg/kg intravenously before propofol injection. Vital signs indicators [mean arterial pressure (MAP), heart rate (HR), and percutaneous arterial oxygen saturation (SpO₂)] were compared between the two groups at the time of entry (T₀), immediately after anesthesia induction (T₁), immediately after gastroscopy placement (T₂), immediately upon completion of gastroscopy (T₃), immediately after colonoscopy insertion (T₄), and immediately upon completion of colonoscopy examination (T₅). The anesthesia effect was evaluated for the two groups during painless gastroenteroscopy examination. The duration of gastroenteroscopy and propofol dosage were compared between the two groups as well. Visual analogue scale (VAS) score was used to evaluate the postoperative pain level for patients from the two groups 1, 2, 3, and 4 h after surgery. Intraoperative and postoperative adverse reactions in two groups were recorded.Results The MAP at T₃, T₄, and T₅ time points in observation group were lower than that at T₀ time point, the HR at T₄ and T₅ time point in observation group was lower than that at T₀ time point, the differences were statistically significant (P < 0.05), there was no significant difference in SpO₂ at each time point in observation group (P > 0.05). While the MAP, HR, and SpO₂ at T₁, T₂, T₃, T₄, and T₅ time points in control group were significantly lower than those at T₀ time points, the differences were statistically significant (P < 0.05). The MAP, HR, and SpO₂ at T₁, T₂, T₃, T₄, and T₅ time points in control group were lower than those in observation group, the differences were statistically significant (P < 0.05). The excellent and good rate of anesthesia in observation group was better than that in control group, the difference was statistically significant (P < 0.05). The propofol dosage in observation group was less than that in control group, the recovery time in observation group was shorter than that in control group, the differences were statistically significant (P < 0.05). There were no significant differences in duration of gastroenteroscopy examination, postanesthesia care unit (PACU) stay and leave hospital time between the two groups (P > 0.05). 1, 2, 3, and 4 h postoperative pain VAS scores in observation group were less than those in control group, the differences were statistically significant (P < 0.05). The incidence of respiratory depression was 3.23%, which was significantly lower than 19.35% in control group, the incidence of hypotension was 4.84%, which was significantly lower than 25.81% in control group, the incidence of bradycardia was 0.00%, which was significantly lower than 17.74% in control group, the incidence of nausea and vomiting was 1.61%, which was significantly lower than 12.90% in control group, the differences were statistically significant (P < 0.05). There were no significant differences in the incidence of tachycardia, coughing, body movement, and dizziness between the two groups (P > 0.05).Conclusion Application of esketamine combined with butorphanol in painless gastroenteroscopy for elderly patients with obesity can effectively improve sedative and analgesic effects, stabilize hemodynamics, and reduce adverse reactions. It is worthy clinical application.