| Objective:To observe the effects of propofol combined with dexmedetomidine or midazolam on the painless gastrointestinal microscopy of the elderly in clinical effect,safety and adverse reactions.Methods:250 patients who underwent joint painless gastroscopy at the First Affiliated Hospital of Kunming Medical University were selected,with ASA grades Ⅰ-Ⅱ.Random number table method was used to divide the patients into 5 groups(n=50).The patient number of D1 group(0.25 ug/kg dexmedetomidine),D2 group(0.5 ug/kg dexmedetomidine),D3 group(0.75 ug/kg t dexmedetomidine),M group(0.03mg/kg Midazolam)and C group(control group)is 50 cases in each group Dexmedetomidine group(D1,D2,D3 group)were injected dexmedetomidine before surgery within 15 minutes by pump.Midazolam group(M group)were injected midazolam before surgery within 15 minutes by pump.Control group(C group)were injected equal volume saline before surgery within 15 minutes by pump.Fentanyl(0.1ug/kg)and propofol(1.5mg-3mg/kg)were intravenously injected in each group until the patient’s eyelash reflex disappeared and gastrointestinal endoscopy was performed.We recorded the patient’s HR,MAP,and SPO2,and the patient’s propofol dosage,examination duration,recovery time and intraoperative adverse reactions at T0(he patient lying 3 minutes),T1(before induction),T2(the beginning of the examination),T3(10 minutes after the beginning of the examination),T4(he Stward score was 6 after the surgery).Results:The dosage of propofol in groups C,D1 and D2 was statistically different from that in groups M and D3(P<0.05).The recovery time of patients in group C,D1 and D2 was shorter than that in group D3 and M(P<0.05).From T1 to T4,the heart rate of group D3 and D2 was statistically significant compared with group D1,M and C(P<0.05).At time T1,patients in groups D3 had lower heart rate than those in D1,M,and C groups,and patients in groups D2 had lower than those in M and C groups(P<0.05).At time T2,patients in groups D3 had lower heart rate than those in D1,D2,M and C groups(P<0.05).patients in groups D2 had lower heart rate than those in D1,,M and C groups(P<0.05).At time T3,patients in groups D3 had lower heart rate than those in D1,D2,M and C groups(P<0.05).Patients in groups D2 had lower heart rate than those in D1 group(P<0.05).At time T4,patients in groups D3 had lower heart rate than those in M and C groups(P<0.05).And patients in groups D3 had lower heart rate than those in C group(P<0.05)..At time T1,patients in groups D1,D2,and D3 had lower MAP than those in group C(P<0.05),and groups D3 were lower than group M(P<0.05);at time T2,patients in groups D3 and C had lower MAP than groups D1,M Group(P<0.05).At time T3,SP02 in group D1 was higher than that in group C(P<0.05).As body movements occur,the satisfaction of the digestive physician decreases.The risk factor for respiratory depression is the BMI value;and the control group is more likely to cause respiratory depression than the midazolam group and the midazolam group than the dexmedetomidine group.The control group is more likely to cause tachycardia than the midazolam group and the midazolam group than the dexmedetomidine group,and the risk factor for bradycardia is the BMI value;and the control group is more than the midazolam group and midazolam.Bradycardia group decreased bradycardia compared with dexmedetomidine group.The incidence of respiratory depression in groups D1,D2,D3 was lower than group C(P<0.05).The incidence of respiratory depression in group D2 was lower than that of group M(P<0.05).The incidence of bradycardia in groups D1,D2,M,and C was lower than that of group D3(P<0.05).The incidence of bradycardia in groups C,D1 and M was lower than that in group D2(P<0.05).The incidence of body movement in group D3 was lower than that in groups D1,D2,M and C(P<0.05).The incidence of POCD in group M2 was higher than that in group D(P<0.05).Conclusion:The medium-dose dexmedetomidine(0.5 ug/kg)combining with propofol is a better dosing regimen in painless gastrointestinal examination on the elderly.It can provide better sedation,fewer adverse reactions and high satisfaction of physicians.Objective:To study the effects of propofol combined with dexmedetomidine,propofol combined with midazolam and propofol sedation on the cognitive function of elderly patients with painless gastroscopy.Methods:90 patients with painless gastrointestinal endoscopy were selected from the First Affiliated Hospital of Kunming Medical University,aged 60-75 years old,ASA grade Ⅰ-Ⅱ.Random number table method was used to divide the patients into 3 groups(n=30).The injection route and time of D group(0.5 ug/kg dexmedetomidine),M group(0.03mg/kg midazolam)and C group(control group)are same with the part one.MMSE and MOCA score sheet was used to evaluate cognitive function of the elderly at T0(before surgery),T1(5 minutes after waking up),T2(30 minutes after waking up),T3(1 hour after waking up),T4(2 hour after waking up),T5(6 hour after waking up).We record the propofol dosage,examination duration,recovery time and intraoperative adverse reactions.Results:At T1,the MMSE score of group D patients was higher than that of M group(P<0.05);at T3(wake up 1h),the MMSE score of group C patients was higher than that of M group(P<0.05).At time T1,the MOCA scores of patients in groups D and C were higher than those in group M(P<0.05).The POCD positive rate of the MOCA score at each time in each group was higher than that of MMSE.The incidence of POCD ranges from high to low in group M,group C,and group D.Hypotension and respiratory depression risk factors for POCD.Conclusion:The mode of administration of propofol combined with dexmedetomidine(0.5ug/kg),MMSE score and MOCA score was higher than propofol combined with midazolam at 5 minutes of recovery. |
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