Abstract:

Objective　To investigate the effects of remifentanil combined with different doses of dexmedetomidine on cognitive function, plasma insulin, and blood glucose in elderly diabetic patients undergoing painless gastrointestinal endoscopy. Methods　This prospective study selected 179 elderly diabetic patients who underwent painless gastrointestinal endoscopy at Xidian Group Hospital from January 2020 to January 2024. Patients were randomly divided into a low-dose group (89 cases) and a high-dose group (90 cases) using a random number table method. In the low-dose group, there were 48 males and 41 females, with an average age of (68.64±7.35) years and a diabetes duration of (8.35±1.46) years. In the high-dose group, there were 46 males and 44 females, with an average age of (67.46±8.23) years and a diabetes duration of (8.74±1.35) years. The low-dose group received intravenous remifentanil at 0.2 mg/kg + dexmedetomidine at 0.5 µg/kg, while the high-dose group received intravenous remifentanil at 0.2 mg/kg + dexmedetomidine at 1.0 µg/kg. General data for both groups were collected. Hemodynamic parameters, blood glucose, plasma cortisol, and adrenaline levels were statistically analyzed and compared at five time points: after admission (T₀), at the start of anesthesia induction (T₁), upon completion of anesthetic drug administration (T₂), 2 minutes after endoscopy (T₃), and 2 minutes after recovery (T₄). Additionally, the time to disappearance of the eyelash reflex, Ciprofol dosage, recovery time after anesthesia, and gastrointestinal function were compared between the two groups. The cognitive function (Mini-Cog score), recovery quality [ Richmond sedation-agitation scale (RASS), visual analogue scale (VAS) score ] and adverse reactions during the examination were statistically compared between the two groups before and after the examination. Statistical analyses were conducted using χ², t, and F tests. Results　The mean arterial pressure (MAP), heart rate (HR), peripheral blood oxygen saturation (SpO₂), and respiratory rate (RR) at T₀, T₁, T₂, T₃, and T₄ showed statistically significant differences (all P<0.05). There were significant differences in MAP, HR, SpO₂ and RR between the two groups at T₁, T₂, T₃ and T₄(F=76.565, 31.402, 11.852, 24.236, all P<0.001). The trends in changes of MAP, HR, SpO₂, and RR between the two groups were statistically significant (all P<0.05). Comparisons of blood glucose, insulin, plasma cortisol, and adrenaline levels at different time points also showed statistically significant differences (all P<0.05). The levels of blood glucose, insulin, plasma cortisol, and adrenaline at T₁, T₂, T₃ and T₄ in the high-dose group were lower than those in the low-dose group (F=156.364, 1 208.490, 91.566, 46.861, all P<0.001), with smaller fluctuations. The trends in changes of blood glucose, insulin, plasma cortisol, and adrenaline levels between the two groups were statistically significant (all P<0.05). The disappearance time of eyelash reflex in the high-dose group was shorter than that in the low-dose group [(2.60±0.45) min vs. (2.78±0.55) min], and the dosage of propofol in the high-dose group was less than that in the low-dose group [(81.35 ±13.24) mg vs. (122.45±23.13) mg]. The time to call for eye-opening and the time to regain orientation in the high-dose group were (10.76±1.21, 19.67±1.23) min, both longer than those in the control group [(7.56±1.68, 17.12±0.98) min], with statistically significant differences (all P<0.05). The recovery time of bowel sounds, time to pass gas, and time to defecate in the high-dose group were (2.01±0.77) d (16.75±5.31) h, and (2.12±0.44) d, respectively, all longer than those in the low-dose group [(1.26±0.43) d, (7.13±4.11) h, (1.21±0.57) d] (all P<0.05). The Mini-Cog scores in the high-dose group were lower than those in the low-dose group [(2.68±0.96) points vs. (3.03±0.67) points]. The Ramsay sedation scores in the high-dose group were higher than those in the low-dose group [(1.73±0.13) points vs. (1.60±0.12) points], while the RASS and VAS scores were lower in the high-dose group [(1.66±0.12)points vs. (1.82±0.11) points, (1.85±0.21) points vs. (1.96±0.27) points)], with statistically significant differences (t=2.826, 6.950, 9.296, 3.044, all P<0.05). Conclusion　Ciprofol combined with different doses of dexmedetomidine in painless gastrointestinal endoscopy for elderly diabetic patients shows that the high-dose group has advantages in maintaining stable hemodynamic indices, lower blood sugar and insulin levels, and quicker functional recovery without increasing the risk of adverse reactions. This indicates that the dosage can be adjusted according to the specific clinical situation of patients to optimize treatment effects and patient safety.

Key words:

Ciprofol, Dexmedetomidine, Painless gastrointestinal endoscopy, Cognitive function, Elderly diabetes, Plasma insulin

摘要：

目的　探讨环泊酚联合不同剂量右美托咪定对老年糖尿病患者无痛胃肠镜检查的效果及对其认知功能、血浆胰岛素及血糖的影响。方法　前瞻性选取2020年1月至2024年1月在西电集团医院进行无痛胃肠镜检查的老年糖尿病患者179例为研究对象，利用随机数字表法分为小剂量组（89例）与大剂量组（90例）。小剂量组中男48例、女41例，年龄（68.64±7.35）岁，糖尿病病程（8.35±1.46）年。大剂量组中男46例、女44例，年龄（67.46±8.23）岁，糖尿病病程（8.74±1.35）年。小剂量组静脉泵入环泊酚0.2 mg/kg+右美托咪定0.5 µg/kg，大剂量组静脉泵入环泊酚0.2 mg/kg+右美托咪定1.0 µg/kg。收集两组患者一般资料。统计并比较两组患者入室后（T₀）、麻醉诱导开始（T₁）、麻醉诱导药物推注完毕（T₂）、下镜后2 min（T₃）、出镜后2 min（T₄）的血流动力学指标、血糖、血浆皮质醇、肾上腺素水平。比较两组患者睫毛反射消失时间、丙泊酚使用剂量、麻醉后恢复时间及胃肠功能。统计并比较两组患者检查前后认知功能［简易认知评估量表（Mini-Cog）评分］、苏醒质量［Ramsay镇静评分、Richmond镇静-躁动量表（RASS）、视觉模拟评分法（VAS）评分］及检查过程中不良反应发生情况。采用χ²、t、F检验进行统计分析。结果　T₀、T₁、T₂、T₃、T₄的平均动脉压（MAP）、心率、外周血氧饱和度（SpO₂）、呼吸频率（RR）比较，差异均有统计学意义（均P<0.05）；两组T₁、T₂、T₃、T₄的MAP、心率、SpO₂、RR比较，差异均有统计学意义（F=76.565、31.402、11.852、24.236，均P<0.001）；两组MAP、心率、SpO₂、RR变化趋势比较，差异均有统计学意义（均P<0.05）。不同时间点血糖、胰岛素、血浆皮质醇、肾上腺素水平比较，差异均有统计学意义（均P<0.05）；大剂量组T₁、T₂、T₃、T₄的血糖、胰岛素、血浆皮质醇、肾上腺素水平均低于小剂量组（F=156.364、1 208.490、91.566、46.861，均P<0.001），变化波动较小；两组血糖、胰岛素、血浆皮质醇、肾上腺素水平变化趋势比较，差异均有统计学意义（均P<0.05）。大剂量组的睫毛反射消失时间短于小剂量组［（2.60±0.45）min比（2.78±0.55）min］，丙泊酚使用剂量少于小剂量组［（81.35±13.24）mg比（122.45±23.13）mg］，呼唤睁眼时间、定向力恢复时间均长于对照组［（10.76±1.21、19.67±1.23）min比（7.56±1.68、17.12±0.98）min］，差异均有统计学意义（均P<0.05）。大剂量组肠鸣音恢复时间、排气时间、排便时间分别为（2.01±0.77）d、（16.75±5.31）h、（2.12±0.44）d，均长于小剂量组［（1.26±0.43）d、（7.13±4.11）h、（1.21±0.57）d］（均P<0.05）。大剂量组的Mini-Cog评分、RASS、VAS评分均低于小剂量组［（2.68±0.96分）比（3.03±0.67）分、（1.66±0.12）分比（1.82±0.11）分、（1.85±0.21）分比（1.96±0.27）分］，Ramsay镇静评分高于小剂量组［（1.73±0.13）分比（1.60±0.12）分］，差异均有统计学意义（t=2.826、9.296、3.044、6.950，均P<0.05）。结论　环泊酚联合不同剂量右美托咪定用于老年糖尿病患者无痛胃肠镜检查，大剂量组在维持稳定的血流动力学指标、较低的血糖和胰岛素水平以及较快的功能恢复方面具有优势，且未增加不良反应的发生风险。

关键词:

环泊酚, 右美托咪定, 无痛胃肠镜, 认知功能, 老年糖尿病, 血浆胰岛素