低剂量艾司氯胺酮联合右美托咪定对老年无痛胃镜检查患者生命体征与术后恢复、精神活动的影响

Effects of low dose esketamine combined with dexmedetomidine on vital signs, postoperative recovery and mental activity in elderly patients undergoing painless gastroscopy

摘要:

目的 探讨低剂量艾司氯胺酮联合右美托咪定对老年无痛胃镜检查患者生命体征与术后恢复、精神活动的影响。方法 选取2022年12月—2024年5月中山市第五人民医院行无痛胃镜检查的150例老年患者，采用随机数字表法分为研究组与对照组，各75例。对照组给予低剂量艾司氯胺酮联合丙泊酚麻醉，研究组给予低剂量艾司氯胺酮联合右美托咪定麻醉。比较两组患者不同时间点［麻醉前（T₀）、胃镜检查开始时（T₁）、胃镜进入胃内时（T₂）、胃镜完全退出口腔时（T₃）］的平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO₂），检查前30 min及满足离开复苏室标准时精神活动测试情况，统计苏醒时间、复苏室停留时间、不良反应发生率。结果 研究组与对照组T₀、T₁、T₂、T₃时MAP、HR、SpO₂比较，结果 ①不同时间点MAP、HR、SpO₂比较，差异有统计学意义（P <0.05）；②两组MAP、HR比较，差异有统计学意义（P <0.05）；两组SpO₂比较，差异无统计学意义（P >0.05）；③两组MAP、HR变化趋势比较，差异有统计学意义（P <0.05）；两组SpO₂变化趋势比较，差异无统计学意义（P >0.05）。研究组苏醒时间短于对照组（P <0.05）。研究组与对照组复苏室停留时间的比较，差异无统计学意义（P >0.05）。研究组满足离开复苏室标准时与检查前30 min时数字划消准确率的差值小于对照组，插板时间、数字连接时间的差值短于对照组（P <0.05）。研究组注射痛发生率和不良反应总发生率低于对照组（P <0.05）。结论 低剂量艾司氯胺酮联合右美托咪定应用于老年患者无痛胃镜检查中，可维持生命体征平稳，促进苏醒、精神活动的恢复，不良反应少。

Abstract:

Objective To investigate the effects of low dose esketamine combined with dexmedetomidine on vital signs, postoperative recovery and mental activity in elderly patients undergoing painless gastroscopy.Methods A total of 150 elderly patients who underwent painless gastroscopy in hospitals from December 2022 to May 2024 were selected and divided into study group (75 cases) and control group (75 cases) by random number table method. The control group was given low dose esketamine combined with propofol, and the study group was given low dose esketamine combined with dexmedetomidine. The mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SpO₂) of the two groups were compared at different time points (before anesthesia (T₀), when gastroscopy began (T₁), when gastroscopy entered the stomach (T₂), and when gastroscopy completely withdrew from the mouth (T₃), as well as the mental activity test 30 min before examination and when meeting the criteria for leaving the resuscitation room. Recovery time, stay time in resuscitation room and incidence of adverse reactions were analyzed.Results MAP, HR and SpO₂ were compared between the study group and the control group at T₀, T₁, T₂ and T₃, and the analysis of variance with repeated measurement design was used. The results showed that: (1) There were statistically significant differences in MAP, HR and SpO₂ at different time points (P < 0.05). (2) There were significant differences in MAP and HR between the study group and the control group (P < 0.05). There was no significant difference in SpO₂ between study group and control group (P > 0.05). (3) The change trend of MAP and HR between the study group and the control group was statistically significant (P < 0.05). There was no significant difference in SpO₂ between the study group and the control group (P > 0.05). The recovery time of the study group was shorter than that of the control group (P < 0.05). There was no significant difference in the residence time of resuscitation room between the study group and the control group (P > 0.05). The difference values of digital erasability accuracy, insertion time and digital connection time in the study group were lower than those in the control group when they met the standard of leaving the resuscitation room and 30 min before examination (P < 0.05). The incidence of injection pain and the total incidence of adverse reactions in the study group were lower than those in the control group (P < 0.05).Conclusions The application of low-dose esketamine combined with dexmedetomidine in painless gastroscopy in elderly patients can maintain stable vital signs, promote awakening and recovery of mental activities, and have fewer adverse reactions.