不同剂量纳布啡复合丙泊酚静脉麻醉用于老年无痛胃镜的效果及对神经认知紊乱的影响

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摘要目的比较不同剂量纳布啡复合丙泊酚静脉麻醉用于老年无痛胃镜的效果和对神经认知紊乱的影响。方法选择2019年3—12月四川省广元市朝天区人民医院拟行胃镜的老年患者150例，采用信封法随机分为N1、N2和N3组，每组50例。分别静注纳布啡0.06、0.08及0.10 mg/kg，2 min后静注丙泊酚和胃镜检查。记录纳布啡注入前（T0）、丙泊酚注入前（T1）、置胃镜前（T2）、胃镜达十二指肠（T3）、结束时（T4）、苏醒后（T5）的收缩压（SBP）、舒张压（DBP）、心率（HR）、呼吸频率（RR）及脉搏血氧饱和度（SpO2）；记录麻醉起效时间、胃镜时间、苏醒和离院时间、丙泊酚用量及并发症的发生率。采用认知评估量表（MoCA）评价离院时（T6）、术后24 h（T7）及术后72 h（T8）神经认知功能。结果三组不同时间点SBP、DBP、HR比较，差异均有统计学意义（均P ＜ 0.05），组间比较与交互作用差异均无统计学意义（均P ＞ 0.05）。与T0和T1比较，三组SBP、DBP、HR在T2～T4均降低。三组RR与SpO2时间点比较、组间比较及交互作用差异均无统计学意义（均P ＞ 0.05）。与N1组比较，N2、N3组苏醒和离院时间缩短，丙泊酚用量减少，差异均有高度统计学意义（均P ＜ 0.01）。N3组苏醒和离院时间较N2组延长，差异有统计学意义（P ＜ 0.05）。其余指标组间比较差异均无统计学意义（均P ＞ 0.05）。N2、N3组SpO2＜90%及术后疼痛发生率较N1组降低，差异均有统计学意义（P ＜ 0.05或P ＜ 0.01），其余指标发生率组间比较，差异无统计学意义（P ＞ 0.05）。三组MoCA评分时间点比较，组间比较差异有统计学意义（P ＜ 0.05），交互作用差异均无统计学意义（均P ＞ 0.05）。组内比较：三组各时间点比较，差异均有统计学意义（均P ＜ 0.05）。组间比较：N2、N3组在T6、T7时MoCA评分较N1组增加，差异均有统计学意义（均P ＜ 0.05），N2和N3组在T6～T8时MoCA评分比较，差异均无统计学意义（均P ＞ 0.05）。结论纳布啡0.08 mg/kg复合丙泊酚用于老年无痛胃镜的麻醉中能缩短苏醒时间、减少丙泊酚的用量，降低神经认知紊乱的发生。

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	柴天波1 杨川1 赵泽宇2 郭津锦1 武天珍1 杨利蓉1 邹正莲1

关键词 ：纳布啡, 二异丙酚, 胃镜, 认知, 老年人

Abstract：Objective To compare the effects of different doses of Nalbuphine combined with Propofol on the elderly painless gastroscopy and its effects on neurocognitive disorders. Methods From March to December 2019, a total of 150 elderly patients who in the People′s Hospital of Chaotian District In Guangyuan, Sichuan Province, planned to undergo gastroscopy were randomly divided into N1, N2 and N3 groups by envelope method, with 50 patients in each group. Nalbuphine 0.06, 0.08 and 0.10 mg/kg were intravenous injected, Propofol was injected two minutes later and gastroscopy was performed. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), and pulse oxygen saturation (SpO2) were recorded before Nalbuphine injection (T0), before Propofol injection (T1), before gastroscopy placement (T2), gastroscopy reaching the duodenum (T3), at the end of examination (T4) and after awakening (T5). Onset time of anesthesia, gastroscope time, time of waking and leaving hospital, Propofol dosage, and incidence of complications were recorded. The montreal cognitive assessment scale (MoCA) was used to evaluate the neurocognitive function at the time of discharge (T6), postoperative 24 h (T7) and postoperative 72 h (T8). Results SBP, DBP and HR of the three groups were compared at different time points and the differences were statistically significant (all P ＜ 0.05), while the intergroup comparison and interaction among the three groups were not statistically significant (all P ＞ 0.05). Compared with T0 and T1, SBP, DBP and HR in the three groups were all decreased in T2 to T4. There were no statistically significant differences in RR and SpO2 at time points, intergroup comparison and interaction among the three groups (all P ＞ 0.05). Compared with N1 group, the time of waking and leaving hospital in N2 and N3 groups were shorter and Propofol consumption were reduced, with statistically significant differences (P ＜ 0.05 or P ＜ 0.01). The time of waking and leaving hospital in N3 group was longer than that in N2 group, and the difference was statistically significant (P ＜ 0.05). There were no significant differences in the other indexes (all P ＞ 0.05). SpO2 < 90% and postoperative pain incidence in N2 and N3 groups were lower than N1 group, and the differences were highly statistically significant (all P ＜ 0.01), while the differences in the incidence of other indicators were not statistically significant (all P ＞ 0.05). MoCA score time points and intergroup comparison among the three groups showed statistically significant differences (all P ＜ 0.05), while the interaction difference was not statistically significant (P ＞ 0.05). Intra-group comparison: there were statistically significant differences among the three groups at each time point (all P ＜ 0.05). Comparison between groups: the MoCA score of N2 and N3 groups increased at T6 and T7 compared with N1 group, and the differences were statistically significant (all P ＜ 0.05); the MoCA score of N2 and N3 groups showed no statistically significant difference at T6 to T8 (P ＞ 0.05). Conclusion Nalbuphine 0.08 mg/kg combined with Propofol can shorten the recovery time, waking the dosage of Propofol and reduce the occurrence of neurocognitive disorders in the elderly patients during the anesthesia of painless gastroscopy.

Key words： Nalbuphine Propofol Gastroscopy Cognitive Elderly

基金资助:四川省卫生健康委员会科研课题（18PJ184）。

通讯作者: 赵泽宇（1970.7-），男，主任医师，硕士生导师；研究方向：临床麻醉。

作者简介: 柴天波（1985.10-），男，副主任医师；研究方向：临床麻醉。

引用本文:

柴天波1 杨川1 赵泽宇2 郭津锦1 武天珍1 杨利蓉1 邹正莲1. 不同剂量纳布啡复合丙泊酚静脉麻醉用于老年无痛胃镜的效果及对神经认知紊乱的影响[J]. 中国医药导报, 2020, 17(31): 126-129,157.
CHAI Tianbo1 YANG Chuan1 ZHAO Zeyu2 GUO Jinjin1 WU Tianzhen1 YANG Lirong1 ZOU Zhenglian1. Effect of intravenous anesthesia with different doses of Nalbuphine combined with Propofol on elderly painless gastroscopy and its effects on neurocognitive disorders. 中国医药导报, 2020, 17(31): 126-129,157.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I31/126

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