阿芬太尼复合瑞马唑仑在老年心肺功能不全患者无痛胃肠镜检查中的效果

doi:10.3760/cma.j.issn.1007-1245.2024.21.021

摘要/Abstract

摘要：

目的　探讨阿芬太尼复合瑞马唑仑对老年心肺功能不全无痛胃肠镜检查患者生命体征及认知功能的影响。方法　该研究为前瞻性研究，选择2021年1月至2023年12月西安市中心医院接受无痛胃肠镜检查的84例老年心肺功能不全患者作为研究对象，按随机数字表法分为两组，各42例。对照组男22例，女20例；年龄65～84（72.78±4.69）岁，给予纳布啡复合瑞马唑仑麻醉；研究组男19例，女23例；年龄66～85（72.80±4.72）岁，给予阿芬太尼复合瑞马唑仑麻醉。对比两组患者给药前1 min（T0）、进镜操作即刻（T1）、操作开始后1 min（T2）、操作开始后10 min（T3）、操作结束即刻（T4）生命体征，麻醉清醒后5、30 min时镇静、镇痛效果，以及麻醉相关指标、认知功能。统计学方法采用t检验、χ²检验。结果　与T0相比，两组患者T1～T4时刻平均动脉压（MAP）、心率（HR）、呼吸频率（RR）水平均降低，研究组均高于对照组（均P<0.05）；研究组患者不同时刻脉搏氧饱和度（SpO₂）水平差异无统计学意义（P>0.05），对照组患者T1～T4时刻SpO₂水平均较T0时降低（P<0.05）。研究组患者麻醉清醒后5 min、30 min时视觉模拟评分法（VAS）及Ramsay评分均较对照组低（均P<0.05）。研究组患者麻醉起效时间、苏醒时间、定向力恢复时间、术毕至离开时间均较对照组短［（1.33±0.27）min比（1.55±0.34）min、（5.63±1.22）min比（9.48±1.31）min、（7.81±0.57）min比（10.32±1.15）min、（8.16±1.26）min比（10.25±1.58）min］，差异均有统计学意义（t=3.28、13.94、12.63、6.70，均P<0.05）。研究组患者在术中及术后60 min内麻醉所致各类不良事件发生率均低于对照组（均P<0.05）。术后苏醒即刻，两组患者蒙特利尔认知量表（MoCA）评分与简易精神状态量表（MMSE）评分比较，差异均无统计学意义（均P>0.05）；术后1 h，研究组MMSE评分、MoCA评分均较对照组高［（28.75±2.42）分比（27.06±2.18）分、（29.15±2.14）分比（27.13±2.36）分］，差异均有统计学意义（t=3.36、4.11，均P<0.05）。结论　对老年无痛胃肠镜检查患者应用阿芬太尼复合瑞马唑仑麻醉方案，可有效维持患者生命体征稳定，提高镇痛镇静效果，缩短麻醉起效与恢复时间，降低不良事件与术后认知障碍发生风险。

关键词:

阿芬太尼, 瑞马唑仑, 心肺功能不全, 无痛胃肠镜检查, 生命体征, 老年人

Abstract:

Objective　To investigate the effects of afentanil combined with remazolam on vital signs and cognitive function in elderly patients with cardiopulmonary insufficiency taking painless gastroenteroscopy. Methods　A total of 84 elderly patients with cardiopulmonary insufficiency who took painless gastroenteroscopy at Xi'an Central Hospital from January 2021 to December 2023 were selected for the randomized controlled trial, and were divided into a control group and a study group by the random number table method, with 42 cases in each group. There were 22 males and 20 females in the control group; they were 65-84 (72.78±4.69) years old. There were 19 males and 23 females in the study group; they were 66-85 (72.80±4.72) years old. The control group were given nalbuphine and remazolam for anesthesia, and the study group afentanil and remazolam. The vital signs 1 min before administration (T0), at putting the scope in (T1), 1 (T2) and 10 (T3) min after starting the operation, and when the operation was over (T4), sedative and analgesic effects 5 and 30 min after recovery from anesthesia, anesthetic indicators, and cognitive function were compared between the two groups. t and χ² tests were applied. Results　The mean artery pressures (MAP), heart rates (HR), and respiratory rates (RR) at T1, T2, T3, and T4 were lower than those at T0 in both groups, and the MAP, HR, and RR in the study group were higher than those in the control group (all P<0.05). There was no statistical difference in the pulse oxygen saturation (SpO₂) between at different time points in the study group (P>0.05); the SpO₂ at T1, T2, T3, and T4 were lower than that at T0 in the control group (P<0.05). The scores of Visual Analogue Scale (VAS) and Ramsay 5 and 30 min after recovery from anesthesia in the study group were lower than those in the control group (all P<0.05). The anesthesia onset time, recovery time, orientation recovery time, and the time from the end of the operation to departure in the study group were shorter than those in the control group [(1.33±0.27) min vs. (1.55±0.34) min, (5.63±1.22) min vs. (9.48±1.31) min, (7.81±0.57) min vs. (10.32±1.15) min, and (8.16±1.26) min vs. (10.25±1.58) min], with statistical differences (t=3.28, 13.94, 12.63, and 6.70; all P<0.05). The incidences of adverse events during the operation and within 60 min after the operation in the study group were lower than those in the control group (all P<0.05). There were no statistical differences in the scores of Montreal Cognitive Assessment (MoCA) and Mini-mental state examination (MMSE) at recovery after the operation between the two groups (both P>0.05). One hour after the operation, the scores of MMSE and MoCA in the study group were higher than those in the control group [(28.75±2.42) vs. (27.06±2.18) and (29.15±2.14) vs. (27.13±2.36)], with statistical differences (t=3.36 and 4.11; both P<0.05). Conclusion　The application of afentanil and remazolam in elderly patients taking painless gastroenteroscopy can effectively maintain their vital signs stable, improve the analgesic and sedative effects, shorten the onset and recovery times of anesthesia, and reduce the risk of adverse events and postoperative cognitive impairment.

Key words:

Afentanil, Remazolam, Cardiopulmonary insufficiency, Painless gastroenteroscopy, Vital signs, The elderly

王坤郭强路凯.

阿芬太尼复合瑞马唑仑在老年心肺功能不全患者无痛胃肠镜检查中的效果 [J]. 国际医药卫生导报, 2024, 30(21): 3629-3634.

Wang Kun, Guo Qiang, Lu Kai.

Application of afentanil and remazolam in painless gastroenteroscopy for elderly patients with cardiopulmonary insufficiency [J]. International Medicine and Health Guidance News, 2024, 30(21): 3629-3634.

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