Observational Study In Effect Of Propofol Combined With Dexmedetomidine On Hemodynamics And Sleep Quality Of Elderly Patients Undergoing Painless Colonoscopy

Objective:The purpose of this study is to observe the effects of propofol combined with dexmedetomidine on intraoperative hemodynamic changes and postoperative sleep quality in elderly patients undergoing painless colonoscopy.Methods:In this study,102 senile inpatients with American Society of Anesthesiologists（ASA）class I～III,aged≥65 years old,and BMI 18.5 to 23.9 kg/m² who voluntarily underwent painless colonoscopy were included and signed an informed consent.Patients enrolled in this study were randomly divided into propofol group（group C,n=51）and propofol combined with dexmedetomidine group（group D,n=51）.Group C:An equal volume of saline as dexmedetomidine was pumped before procedure.10 minutes later,propofol 0.5-2mg kg^-1 was injected to induce the disappearance of eyelash reflex in patients,and propofol 2-4mg·kg^-1·h^-1 was pumped to maitain sedation during procedure.Group D:the bolus dose of dexmedetomidine was 1μg·kg^-1 before procedure.After 10 minutes of infusion,0.5～2mg·kg^-1 propofol was injected intravenously to induce the disappearance of eyelash reflex,and 0.5μg·kg^-1·h^-1 dexmedetomidine was injected during the procedure to maintain.The BIS value was maintained at 45～55 during the procedure,and the hemodynamic indexes were monitored by CNAP non-invasive hemodynamic monitor.Recorded MAP,CO,SVR,SV,HR and SpO₂ at five time points:before anesthesia（T₀）,during insertion（T₁）,splenic flexure（T₂）,hepatic flexure（T₃）and recovery（T₄）in the two groups.Recorded sleep quality of all patients assessed by Pittsburgh Sleep Quality Scale before and on the night,3 days and 7 days after examination and recorded the incidence of intraoperative and postoperative hypotension,hypoxemia,nausea and vomiting,abdominal pain,somnolent and other adverse reactions was recorded in two groups.Results:1.There was no significant difference in age,sex,ASA grade and BMI between the two groups.2.In terms of hemodynamic:There was no significant difference in MAP,CO,SVR and SV between the two groups at T₀（P>0.05）.SVR in group D at T₁～T₄ gradually decreased compared with T₀ after administration,but there was no significant difference（P>0.05）.The CO and MAP in group D at T₁～T₄ gradually decreased compared with T₀（P<0.05）.SV at T₁～T₄ in group D had no significant change compared with T₀（P>0.05）.HR,CO,SVR,MAP and SV at T₁ to T₃ after administration in group C gradually decreased compared with T₀（P<0.05）.HR,CO,SVR,MAP and SV in group C at T₄ returned to T₀ level（P>0.05）.SVR,MAP and SV at T₁～T₂ in group C were lower than those in group D（P<0.05）,CO in group C is lower than that in group D（P<0.05）.The effect of administration on CO,MAP,SV and SVR in group C was more significant than that in group D（P<0.05）.The change of HR in group D was more significant than that in group C after administration（P<0.05）.3.In terms of sleep,the sleep quality of patients in group D was better than that in group C on the night after procedure（P<0.05）.The sleep quality of the night after procedure in group C was worse than that before procedure（P<0.05）.The sleep quality of the patients in group D was slightly better than that before procedure,and the sleep quality in the two groups returned to the baseline level on the third day after procedure.4.The incidence of intraoperative hypoxemia in group D was significantly lower than that in group C（P<0.05）.The induced dose of propofol in group D was significantly lower than that in group C（P<0.05）.There was no significant difference in the examination time between the two groups（P<0.05）.The recovery time of patients in group D was shorter than that of patients group C（P<0.05）.The time to discharge from PACU of patients in group D was shorter than that of patients in group C（P<0.05）.The intraoperation sedation effect of patients in group D was better than that of patients in group C,and the difference was statistically significant（P<0.05）.5.In terms of postoperative adverse reactions,the incidence of abdominal pain in group D was significantly lower than that in group C（P<0.05）.The incidence of somnolent in group D was slightly higher than that in group C,but the difference had no statistical significance（P>0.05）.Conclusion:The method of pre-injectin of dexmedetomidine combined with propofol can maintain a sufficient depth of sedation,ensure stable hemodynamics,reduce the impact on postoperative sleep quality,reduce the incidence of adverse reactions,and can be safely used for painless colonoscopy in elderly patients.