右美托咪定联合瑞芬太尼对老年内镜逆行胰胆管造影术患者血流动力学、应激反应和认知功能的影响

摘要 目的：观察右美托咪定联合瑞芬太尼对老年内镜逆行胰胆管造影术（ERCP）患者血流动力学、应激反应和认知功能的影响。方法：依据随机数字表法，将南京大学医学院附属南京鼓楼医院于2019年4月~2022年7月期间收治的82例老年ERCP患者分为对照组（n=41，丙泊酚乳状注射液及注射用盐酸瑞芬太尼麻醉）和观察组（n=41，盐酸右美托咪定注射液联合注射用盐酸瑞芬太尼麻醉）。对比两组血流动力学、应激反应、镇静镇痛情况、认知功能、不良反应。结果：观察组睫毛反射消失时（T1）~退镜（T4）时间点心率（HR）、平均动脉压（MAP）低于对照组（P<0.05）。观察组术后3 d（T5）~术后1周（T6）时间点，肾上腺素（E）、促肾上腺皮质激素（ACTH）及皮质醇（COR）低于对照组（P<0.05）。观察组术后6 h Ramsay镇静评分高于对照组，视觉疼痛模拟量表（VAS）评分低于对照组（P<0.05）。观察组的认知功能障碍（POCD）发生率低于对照组（P<0.05）。观察组T5时间点简易精神状态检查表（MMSE）评分高于对照组（P<0.05）。两组不良反应发生率组间比较无差异（P>0.05）。结论：右美托咪定联合瑞芬太尼用于老年ERCP患者具有良好的镇静镇痛作用，能有效改善血流动力学，减轻应激反应，提升认知功能，且具有较好的安全性。

Effects of Dexmedetomidine Combined with Remifentanil on Hemodynamics, Stress Response and Cognitive Function in Elderly Patients with Endoscopic Retrograde Cholangiopancreatography

ABSTRACT Objective: To observe the effects of dexmedetomidine combined with remifentanil on hemodynamics, stress response and cognitive function in elderly patients with endoscopic retrograde cholangiopancreatography (ERCP). Methods: According to random number table method, 82 elderly patients with ERCP who were admitted to Nanjing Gulou Hospital Affiliated to the School of Medicine of Nanjing University from April 2019 to July 2022 were divided into control group (n=41, propofol emulsion injection and remifentanil hydrochloride for injection anesthesia) and observation group (n=41, Dexmedetomidine hydrochloride injection combined with remifentanil hydrochloride anesthesia). Hemodynamics, stress response, sedation and analgesia, cognitive function and adverse reactions were compared in the two groups. Results: The heart rate (HR) and mean arterial pressure (MAP) in the observation group at the time points from when eyelash reflex disappeared (T1) to demirror (T4) were lower than those in the control group (P<0.05). The adrenalin (E), adrenocorticotropic hormone (ACTH) and cortisol (COR) in the observation group at the time points from 3d after operation (T5) to 1 week after operation (T6) were lower than those in the control group (P<0.05). Ramsay sedation score in the observation group at 6h after operation was higher than that in the control group, visual pain analog scale (VAS) score was lower than that in the control group (P<0.05). The incidence rate of postoperative cognitive dysfunction (POCD) in the observation group was lower than that in the control group (P<0.05). The Mini-Mental State Examination (MMSE) score in the observation group at T5 time point was higher than that in the control group (P<0.05). There was no difference in the incidence rate of adverse reactions in the two groups (P>0.05). Conclusion: Dexmedetomidine combined with remifentanil in elderly patients with ERCP has good sedative and analgesic effects, which can effectively improve hemodynamics, reduce stress response, improve cognitive function, and which has good safety.