麻黄碱预先给药在老年低体能患者行无痛胃镜中的应用

Application of ephedrine premedication in analgesic gastroscopy for the elderly with low physical capacity

摘要:

目的 观察在无痛胃镜静脉麻醉中麻黄碱预先给药对低体能老年患者的血流动力学影响。方法 选择2017年4月至2017年8月徐州医科大学附属医院麻醉科行无痛胃镜检查的低体能老年患者70例,随机分成丙泊酚组(对照组)和丙泊酚+麻黄碱组(麻黄碱组),每组35例。给药后待患者入睡、 睫毛反射消失、呼吸平稳后行胃镜检查。观察指标为两组丙泊酚麻醉诱导前(T₁)、麻醉诱导后1 min(T₂)、进镜时(T₃)、进镜后3 min(T₄)、退镜时(T₅)、退镜后5 min(T₆)、苏醒时(T₇)患者心率(HR)、平均动脉压(MAP)及脉搏血氧饱和度(SpO₂)。记录两组患者丙泊酚用量、疼痛评分、麻醉效果(优良率)、离院时间及不良反应发生率。采用SPSS 22.0统计软件进行数据分析,根据数据类型,采用t检验、秩和检验、重复测量设计的方差分析或χ²检验进行分析。结果 对照组T₂~T₇时间点的HR较T₁低(P<0.05),麻黄碱组T₄、T₆较T₁低,麻黄碱组T₂、T₃时间点较对照组HR升高[(76.29±10.59) vs(69.46±8.49)次/min,(81.09±10.16) vs(74.97±8.16)次/min；P<0.05]。两组T₂~T₇时间点的MAP较T₁低(P<0.05),但麻黄碱组在T₂~T₆时间点的MAP较对照组升高,差异有统计学意义[(88.71±6.75) vs(77.29±9.82)mmHg,(93.60±7.38) vs(86.97±10.79)mmHg,(87.09±5.90) vs(81.51±9.92)mmHg,(90.26±5.58) vs(86.34±11.81)mmHg,(83.60±6.56) vs(75.66±10.36)mmHg；P<0.05]。两组T₆时间点SpO₂与T₁比较显著降低(P<0.05),T₂、T₃、T₅较T₁显著升高,但两组各时间点SpO₂比较,差异无统计学意义(P＞0.05)。与对照组相比,麻黄碱组疼痛比例及疼痛评分均显著低于对照组,差异有统计学意义[7(20%) vs 14(40%),1(0,2) vs 0(0,1)分；P<0.05]。麻黄碱组血压下降发生率显著降低[3(9%) vs 20(57%), P<0.05],其余不良反应发生率差异无统计学意义。结论 老年低体能患者丙泊酚麻醉无痛胃镜检查时,麻黄碱预先给药可减轻血流动力学的变化幅度,有利于维持循环稳定,并降低疼痛发生率和强度,较安全可靠。

Abstract:

Objective To determine the effects of ephedrine premedication on hemodynamics in the elderly patients with low physical capacity receiving analgesic gastroscopy under intravenous anesthesia. Methods A total of 70 elderly patients with low physical capacity who were scheduled for analgesic gastroscopy in the Affiliated Hospital of Xuzhou Medical College from April to August 2017 were recruited in this study. They were randomly assigned to propofol group (control group) and propofol+ephedrine group (ephedrine group), with 35 patients in each group. Gastroscopy was performed only after the patients falling asleep, with eyelash reflex disappearance and steady breathing. Heart rate (HR), mean arterial pressure (MAP) and pulse oxygen saturation (SpO₂) were observed and measured at the following time points:before the induction of anesthesia (T₁), 1 min after induction of anesthesia (T₂), at the time or in 3 min after gastroscope placement (T₃ and T₄), at the time or in 5 min after gastroscope withdrawing (T₅ and T₆), and at the time of waking-up (T₇). The amount of propofol, anesthetic effect (excellent rate), discharge time and occurrence of adverse reactions were recorded in both groups. SPSS statistics 22.0 was used to perform the statistical analysis. Student’s t test, rank sum test, repeated measures analysis of variance or Chi-square test was employed for different data types. Results In the control group, HR was lower at the time points T₂-T₆ than at T₁ (P<0.05), and the rate was also lower at T₄ and T₆ than T₁ in the ephedrine group. The ephedrine group had significantly higher HR at T₂ and T₃ than the control group [(76.29±10.59) vs (69.46±8.49) times/min, (81.09±10.16) vs (74.97±8.16)times/min, P<0.05]. MAP was lower in both groups at the time points of T₂-T₇ than T₁ (P<0.05),but the ephedrine group had obviously higher MAP than the control group at T₂-T₆ [(88.71±6.75) vs (77.29±9.82)mmHg, (93.60±7.38) vs (86.97±10.79)mmHg, (87.09±5.90) vs (81.51±9.92)mmHg, (90.26±5.58) vs (86.34±11.81)mmHg, (83.60±6.56) vs (75.66±10.36)mmHg, P<0.05]. For SpO₂, the value was notably lower in the 2 groups at T₆ than T₁ (P<0.05), and it at T₂, T₃ and T₅ was significantly increased than that of T₁, but there was no significant difference in SpO₂ between the 2 groups at every time point (P>0.05). Compared with the control group, the pain rate and pain score in the ephedrine group were significantly lower [7(20%) vs 14(40%), 1(0,2) vs 0(0,1) scores, P<0.05]. The incidence of blood pressure decrease was significantly reduced in the ephedrine group than in the other group [3(9%) vs 20(57%), P<0.05], and the incidence of other adverse reactions was not statistically significant. Conclusion Premedication of ephedrine can reduce the variability of hemodynamics in the elderly patients with low physical capacity undergoing analgesic gastroscopy. It is helpful to maintain the stability of the circulatory function, and can reduce the incidence and intensity of pain, with safety and reliability.