Department of Anesthesiology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China.
Department of Anesthesiology, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China.
Clin Ther. 2019 Sep;41(9):1864-1877.e0. doi: 10.1016/j.clinthera.2019.06.011. Epub 2019 Jul 23.
To investigate the optimal agent combined with propofol for sedation in elderly patients undergoing gastrointestinal endoscopy.
A total of 120 elderly patients scheduled for gastrointestinal endoscopy under propofol-based sedation were randomly allocated to receive propofol + saline (control group), propofol + sufentanil 0.1 μg/kg, propofol + dexmedetomidine 0.4 μg/kg, or propofol + ketamine 0.4 mg/kg. Mean arterial pressure, heart rate, pulse oximetry, pressure of end-tidal carbon dioxide, respiratory rate, and Ramsay sedation scale score were recorded. Induction time, procedure time, recovery time, propofol dose, and adverse events were also recorded.
During the sedation procedure, the AUC of HR was lowest in the propofol + dexmedetomidine group (all, P < 0.05), and the AUC of pulse oximetry was significantly higher in the propofol + dexmedetomidine and propofol + ketamine groups compared to the other 2 groups (both, P < 0.05). The propofol + dexmedetomidine group had the highest prevalences of hypotension and bradycardia, and the control group experienced the largest number of hypoxia episodes (all, P < 0.05). The control group consumed the highest dose of propofol, while the propofol + ketamine group needed the lowest dose (all, P < 0.05).
The combination of propofol + ketamine 0.4 mg/kg maintained hemodynamic and respiratory stability, as evidenced by less hypotension, bradycardia, and hypoxia events, in elderly patients undergoing gastrointestinal endoscopy. China clinical trial registration (chictr.org.cn) ID: ChiCTR-INR-17013710.
研究在接受依托咪酯镇静的老年患者中，哪种联合用药是胃肠内镜检查中镇静的最佳选择。
本研究纳入 120 例行依托咪酯镇静下胃肠内镜检查的老年患者，采用随机数字表法将其分为生理盐水（对照组）、0.1μg/kg 舒芬太尼、0.4μg/kg 右美托咪定或 0.4mg/kg 氯胺酮联合依托咪酯组。记录平均动脉压、心率、脉搏血氧饱和度、呼气末二氧化碳分压、呼吸频率和 Ramsay 镇静评分。记录诱导时间、操作时间、苏醒时间、依托咪酯剂量和不良反应。
在镇静过程中，右美托咪定组的 HR 曲线下面积（AUC）最低（P 均＜0.05），且右美托咪定组和氯胺酮组的脉搏血氧饱和度 AUC 明显高于其他 2 组（均 P＜0.05）。右美托咪定组低血压和心动过缓的发生率最高，对照组缺氧的发生率最高（均 P＜0.05）。对照组的依托咪酯用量最高，而氯胺酮组的用量最低（均 P＜0.05）。
在接受胃肠内镜检查的老年患者中，与生理盐水或舒芬太尼相比，依托咪酯与氯胺酮 0.4mg/kg 联合应用可维持血流动力学和呼吸稳定，发生低血压、心动过缓和缺氧的情况更少。中国临床试验注册中心（chictr.org.cn）注册号：ChiCTR-INR-17013710。
