纳布啡联合环泊酚或丙泊酚在老年患者无痛胃肠镜中应用效果分析

doi:10.20223/j.cnki.1000-8535.2024.10.009

摘要/Abstract

摘要： 目的对比纳布啡联合环泊酚、纳布啡联合丙泊酚应用于老年患者无痛胃镜中的效果。方法选取厦门市中医院2021年10月至2022年10月收治的180例老年患者（均行无痛胃肠镜检查）为研究对象,按照随机数表法分组,其中A组90例患者给予纳布啡联合环泊酚,B组90例患者给予纳布啡联合丙泊酚,对比两组患者麻醉相关指标、血流动力学、围术期不良反应。结果两组患者诱导量、诱导时间、追加次数、总追加量、苏醒时间、恢复室停留时间对比差异均无统计学意义（t=1.486、0.830、1.157、0.941、0.906、1.403,均P>0.05）;重复测量方差分析结果显示,分组因素间收缩压（SBP）（F=30.019,P<0.001）、心率（HR）（F=282.057,P<0.001）、SpO₂（F=64.518,P<0.001）、;时间因素SBP（F=21.780,P<0.001）、HR（F=345.118,P<0.001）、SpO₂（F=41.762,P<0.001）;分组与时间交互时间因素SBP（F=12.941,P<0.001）、HR（F=193.295,P<0.001）、SpO₂（F=13.546,P<0.001）,差异均有统计学意义。折线图直观显示,A组患者SBP、HR、SpO₂、较B组低。;A组患者围术期不良反应发生率（20.00%）低于B组患者（56.67%）（χ²=25.593,P<0.001）。结论两种麻醉方案应用于老年无痛胃肠镜,麻醉效果相近,环泊酚复合纳布啡血流动力学更稳定,且围术期不良反应的发生率较低。

关键词: 纳布啡, 环泊酚, 丙泊酚, 无痛胃肠镜

Abstract: Objective To compare the effects of nalbuphine combined with ciprofol and nalbuphine combined with propofol on painless gastroscopy in elderly patients. Methods A total of 180 elderly patients（all underwent painless gastroscopy）admitted to Xiamen Traditional Chinese Medicine Hospital from October 2021 to October 2022 were selected as the study subjects．They were randomly divided into groups using a random number table method．Among them,90 patients in Group A were given a combination of nalbuphine and ciprofol,while 90 patients in Group B were given a combination of nalbuphine and propofol．Anesthesia related indicators,hemodynamics,and perioperative adverse reactions were compared between the two groups．There was no statistically significant difference in the induction amount,induction time,number of additional times,total additional amount,awakening time,and recovery room stay time between the two groups of patients（t=1.486,0.830,1.157,0.941,0.906,1.403,all P>0.05）．The results of repeated measures analysis of variance showed that there were statistically significant differences among the grouping factors,including SBP（F=30.019,P<0.001）,HR（F=282.057,P<0.001）,SpO₂（F=64.518,P<0.001）,time factors SBP（F=21.780,P<0.001）,HR（F=345．118,P<0.001）,SpO₂（F=41.762,P<0.001）,and interaction factors SBP（F=12.941,P<0.001）,HR（F=193.295,P<0.001）,and SpO₂（F=13.546,P<0.001）．The line chart visually shows that the SBP,HR,SpO₂ of Group A patients were lower than those of Group B．The incidence of perioperative adverse reactions in Group A patients（20.00%）was lower than that in Group B patients（56.67%）（χ²=25.593,P<0.001）. Conclusions The two anesthesia regimens used for elderly painless gastroscopy have similar anesthesia effects,with more stable hemodynamics of ciprofol combined with nalbuphine,and a lower incidence of perioperative adverse reactions．

Key words: nalbuphine, ciprofol, propofol, painless gastroscopy

姚一鹏, 朱旭, 游卓玉. 纳布啡联合环泊酚或丙泊酚在老年患者无痛胃肠镜中应用效果分析[J]. 广州医药, 2024, 55(10): 1152-1158.

YAO Yipeng, ZHU Xu, YOU Zhuoyu. Application effect of nalbuphine combined with ciprofol or propofol in painless gastroscopy in elderly patients[J]. Guangzhou Medical Journal, 2024, 55(10): 1152-1158.

参考文献

[1] WANG J,HUANG J,YANG S,et al.Pharmacokinetics and safety of esketamine in Chinese patients undergoing painless gastroscopy in comparison with ketamine:A randomized,open-label clinical study[J].Drug Des Devel Ther,2019(13):4135-4144.
[2] 樊理星,朱易豪,朱涛.丙泊酚和七氟醚对乳腺癌手术后生存率和复发率影响的Meta分析[J].临床麻醉学杂志,2022,38(11):1183-1188.
[3] 高源,刘丽,乔辉,等.新型鼻咽通气道在老年患者无痛胃肠镜诊疗气道管理中的应用[J].临床麻醉学杂志,2023,39(5):497-500.
[4] 史金麟,徐帆,甘建辉,等.小剂量艾司氯胺酮联合环泊酚在老年患者无痛胃肠镜检查中的临床应用[J].实用医院临床杂志,2023,20(1):40-43.
[5] 郭顺,曾晓琴,李波,等.环泊酚与丙泊酚用于腹腔镜胆囊切除术全麻诱导与维持的比较[J].临床麻醉学杂志,2023,39(6):601-604.
[6] 范倩倩,计根林,聂煌,等.小剂量氢吗啡酮复合纳布啡用于胃肠道手术后患者自控静脉镇痛的效果[J].临床麻醉学杂志,2023,39(7):719-724.
[7] 吕艳丽,李毅,刘光顺,等.胃癌高发区血清胃蛋白酶原初筛加高危人群胃镜检查方案与直接胃镜筛查方案的效果比较[J].中华肿瘤杂志,2013,35(5):394-397.
[8] 贺甜,闵秀君,孙喆,等.门诊胃镜检查患者中焦虑抑郁状态与消化不良症状相关性的研究[J].胃肠病学,2022,27(7):399-403.
[9] 李中云,韦晓艳,牙耀,等.不同剂量阿芬太尼复合丙泊酚中长链脂肪乳用于无痛胃镜诊疗的效果评价[J].四川医学,2023,44(1):11-15.
[10] 王博文,李梦迪,韩礼业,等.BIS监测下固定小剂量瑞马唑仑复合丙泊酚在无痛胃肠镜检查中的临床应用[J].重庆医学,2023,52(16):2477-2480,2488.
[11] 黄凤南,徐城,崔珊珊,等.环泊酚单药与联合小剂量舒芬太尼在无痛胃镜检查中的麻醉效果比较[J].武汉大学学报(医学版),2023,44(5):585-589
[12] 郝守则,李子玮.右美托咪定复合丙泊酚和纳布啡对老年无痛胃镜检查患者认知功能的影响观察[J].药物流行病学杂志,2022,31(2):83-87,100
[13] 吴金龙,许敏,王莉珍,等.环泊酚与丙泊酚对髋关节置换术患者围术期炎症指标和术后恢复情况的影响[J].中国临床保健杂志,2023,26(4):556-559.
[14] 占文锋,蔡丽,林枫,等.罗哌卡因局部浸润麻醉配合纳布啡PCIA用于原发性肝癌肝切除术患者的临床研究[J].中国临床药理学杂志,2023,39(22):3243-3247.
[15] 陈靖,朱芸燕,张传武,等.环泊酚在临床麻醉中的应用研究进展[J].国际麻醉学与复苏杂志,2023,44(10):1111-1115.
[15] 崔波,汪海涛,王超,等.小剂量艾司氯胺酮复合环泊酚用于老年患者内镜下逆行胰胆管造影术的效果[J].临床麻醉学杂志,2023,39(3):266-269.
[16] 王超,董星,赵克非.环泊酚复合阿芬太尼用于老年衰弱患者结肠镜检查的效果[J].临床麻醉学杂志,2023,39(5):550-552.
[17] 李志豪,雷蕾,杨建军.环泊酚在老年患者胸腔镜手术静-吸复合麻醉中的有效性与安全性[J].临床麻醉学杂志,2023,39(12):1276-1281.
[18] 贾畅,曹惠鹃,孙莹杰,等.丙泊酚与环泊酚分别复合羟考酮对人流术麻醉效果的随机对照研究[J].实用药物与临床,2022,25(11):1012-1015.
[19] 张翔,朱涛.环泊酚对老年患者无痛胃镜检查时呼吸功能的影响[J].临床麻醉学杂志,2023,39(3):330-332.
[20] 王悠笛,陈亮,孙盈盈,等.环泊酚或丙泊酚复合瑞芬太尼用于无痛纤维支气管镜检查的比较[J].临床麻醉学杂志,2023,39(10):1050-1054.
[21] 孙浩,曹丽,曹林,等.腹腔镜肝切除术治疗原发性肝癌患者应用氢吗啡酮联合纳布啡静脉自控镇痛控制疼痛作用研究[J].实用肝脏病杂志,2022,25(3):415-418.
[22] USACH I,MARTINEZ R,FESTINI T,et al.Subcutaneous injection of drugs:Literature review of factors influencing pain sensation at the injection site[J].Adv Ther,2019,36(11):2986-2996.
[23] 尹征,王路平,郑叶,等.七氟醚与丙泊酚全身麻醉对口腔鳞癌手术患者外周血T淋巴细胞亚群水平的影响[J].临床和实验医学杂志,2022,21(12):1336-1339.
[24] 李进杰,张铁军.甲苯磺酸瑞马唑仑与丙泊酚用于深度镇静下三叉神经痛射频热凝术的比较研究[J].口腔医学研究,2023,39(11):973-977.
[25] HAN R H,HUANG H M,HAN H,et al.Propofol postconditioning ameliorates hypoxia/reoxygenation induced H9c2 cell apoptosis and autophagy via upregulating forkhead transcription factors under hyperglycemia[J].Mil Med Res,2021,8(1):58.