Zhu Xiwen, Chen Xuehan, Zheng Xuemei, Lyu Hongyao, Chen Jie, Yan Ai, Liu Qi, Li Shiqi, Zhang Yamei, Wang Ting, Duan Guangyou, Huang He
Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Department of Preventive Medicine, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China.
Heliyon. 2023 Jun 12;9(6):e17061. doi: 10.1016/j.heliyon.2023.e17061. eCollection 2023 Jun.
Colonoscopy is often accompanied by short-term postoperative cognitive decline. We aimed to explore whether single-use alfentanil for patients undergoing elective colonoscopy could reduce cognitive impairment at discharge compared with propofol.
172 adult patients undergoing elective colonoscopy were randomized to receive intravenous propofol at 2 mg/kg (group P) or alfentanil at 10 μg/kg (group A); 40 healthy volunteers were included in the blank group. Cognitive function was considered the primary outcome and was measured using five neuropsychological tests before sedation and discharge. The z-score method was used to determine cognitive dysfunction according to z-score >1.96 in two types of neuropsychological tests. Other outcomes included discharge time, vital signs, associated adverse events during colonoscopy, and the satisfaction level of patients and endoscopic physicians.
164 patients (78 in group A and 86 in group P) completed the study protocol. At discharge, the incidence of cognitive dysfunction in group P was 23% and was significantly lower in the alfentanil group (2.5%), with a relative risk of 0.11 (95% confidence interval: 0.03-0.46, P < 0.001). The incidence of hypotension in group A was lower than that in group P (3.8% vs 22.1%, relative risk = 0.17 [95% confidence interval: 0.05-0.46, P = 0.001]), and the discharge time in group A was shorter than that in group P (5 [(Rutter and et al., 2016; Zhang and et al., 2013; Hirsh and et al., 2006; Zhou and et al., 2021; Singh and et al., 2008; Ko and et al., 2010; Sargin et al., 2019) 3-93-9 vs 13 [(Ekmekci and et al., 2017; Eberl and et al., 2012; Eberl and et al., 2014; N'Kaoua and et al., 2002; Chung et al., 1995; Berger and et al., 2019; Quan and et al., 2019; Deng and et al., 2021; Gualtieri and Johnson, 2006) 10-1810-18 min, P < 0.001).
For patients undergoing colonoscopy, single-use alfentanil causes less damage to postoperative cognitive function, less risk of hypotension, and shorter discharge time than propofol.
结肠镜检查常伴有术后短期认知功能下降。我们旨在探讨与丙泊酚相比，择期结肠镜检查患者单次使用阿芬太尼是否能降低出院时的认知障碍。
172例接受择期结肠镜检查的成年患者被随机分为两组，分别静脉注射2mg/kg丙泊酚（P组）或10μg/kg阿芬太尼（A组）；40名健康志愿者纳入空白组。认知功能被视为主要结局，在镇静前和出院时使用五项神经心理学测试进行测量。根据两种神经心理学测试中z评分>1.96，采用z评分法确定认知功能障碍。其他结局包括出院时间、生命体征、结肠镜检查期间的相关不良事件以及患者和内镜医师的满意度。
164例患者（A组78例，P组86例）完成了研究方案。出院时，P组认知功能障碍的发生率为23%，阿芬太尼组显著更低（2.5%），相对风险为0.11（95%置信区间：0.03 - 0.46，P < 0.001）。A组低血压的发生率低于P组（3.8%对22.1%，相对风险 = 0.17 [95%置信区间：0.05 - 0.46，P = 0.001]），且A组出院时间短于P组（5 [（鲁特等人，2016年；张等人，2013年；赫什等人，2006年；周等人，2021年；辛格等人，2008年；柯等人，2010年；萨尔金等人，2019年）3 - 93 - 9] 对13 [（埃克梅克奇等人，2017年；埃伯尔等人，2012年；埃伯尔等人，2014年；恩卡瓦等人，2002年；钟等人，1995年；伯杰等人，2019年；全等人，2019年；邓等人，2021年；瓜尔蒂耶里和约翰逊，2006年）10 - 1810 - 18分钟，P < 0.001）。
对于接受结肠镜检查的患者，单次使用阿芬太尼相比丙泊酚对术后认知功能的损害更小，低血压风险更低，出院时间更短。
