不同剂量丙泊酚麻醉对接受无痛胃镜检查老年患者认知功能的影响

摘要

目的:旨在探讨不同剂量丙泊酚麻醉下无痛胃镜检查对老年患者认知功能的影响.方法:选取我院于2013年1月至2015年1月收治接受胃镜检查老年患者200例作为研究对象.随机法将全部入选病例分为无痛胃镜A组、B组、C组和普通胃镜组,每组均50例.无痛胃镜A组静脉注射1.0mg/kg丙泊酚,B组静脉注射1.5mg/kg丙泊酚,C组静脉注射2.0mg/kg丙泊酚后行胃镜检查.普通胃镜组患者仅口服胃镜润滑胶浆后行胃镜检查.对比分析四组患者MAP、HR、BR和SPO2;患者出院1年后,记录和比较四组患者认知能力,日常生活能力和智力情况;观察记录和比较四组患者胃镜检查过程中的不良反应及出院1年后的认知功能障碍(POCD)发生率.结果:不同时间点,无痛胃镜组MAP、HR和BR值改变呈依剂量依赖性递减,无痛胃镜C组MAP、HR和BR值低于无痛胃镜A组(P<0.05).T1和T2时,各无痛胃镜组MAP、HR和BR值均低于无痛胃镜A组(P<0.05).各组SPO2值比较差异无统计学意义(P>0.05).出院1年后,无痛胃镜C组MMSE、MoCA和ADL评分和普通胃镜组差异有统计学意义(P<0.05).无痛胃镜C组不良反应率高于无痛胃镜A组、B组和普通胃镜组,差异具有统计学意义(P<0.05).无痛胃镜C组POCD发生率高于无痛胃镜A组、B组和普通普通胃镜组,差异具有统计学意义(P<0.05).结论:低剂量丙泊酚无痛胃镜检查对老年患者其认知功能影响较小,具有临床推广价值.%Objective:To investigate the influence of different doses of propofol anesthesia in painless gastroscopy in elderly patients with cognitive function Methods: 200 cases of elderly patients admitted in our hospital from January 2013 to January 2015 were selected as study subjects.All the selected cases were randomly divided into group A, group B, group C and the common gastroscopy group, with 50 cases in each group.The patients in painless gastroscopy group A were recived intravenous injection of 1 mg/kg propofol.The patients in group B were recived intravenous injection of 1.5 mg/kg propofol.The patients in group C were injected with 2 mg/kg propofol for gastroscopy.The patients in the ordinary gastroscopy group only received gastroscopy and mucilage mucilage.The mean arterial pressure (MAP), heart rate (HR), respiratory rate (BR) and oxygen saturation (SPO2) of patients were compared during operation.It was recorded and compared four groups of patients with Montreal cognitive assessment scale (MoCA) and activity of daily living scale (ADL) and mini mental state examination (MMSE) score scale after 1 year.The adverse reactions and the incidence of cognitive dysfunction (POCD) in 1 group were compared and observed between the four groups.Results: At different time points, the changes of MAP, HR and BR in the painless gastroscopy group were decreased in a dose-dependent manner, and the MAP, HR and BR values of painless gastroscopy group C were significantly lower than those of painless gastroscopy group A (P<0.05).On T1, T2, MAP, HR and BR values of each group were significantly lower than that of painless gastroscopy group A (P<0.05).There was no significant difference in SPO2 values between the groups (P>0.05).After discharge for 1 years, the MMSE, MoCA and ADL scores of painless gastroscopy group C and were statistically significant (P<0.05).The adverse reaction rate of C group was significantly higher than that in painless gastroscopy group A group, B group and common gastroscopy group (P<0.05).The incidence of POCD in painless gastroscopy group was significantly higher than that in A group, B group and C group (P<0.05).Conclusion: Low dose propofol painless gastroscopy has little effect on the cognitive function of elderly patients has clinical value.