一次麻醉胃肠镜联合检查在老年患者中的临床应用

目的：探讨一次麻醉行胃肠镜联合检查在老年患者中的可行性。方法45例麻醉下行联合胃肠镜检查的年龄≥65岁患者作为老年联合组，与92例分次检查的老年患者（老年分次组）和126例联合检查且年龄＜65岁的非老年患者（非老年联合组）进行对比。比较3组患者的基础疾病、术后苏醒时间、麻醉药用量、术中生命体征的变化以及不良反应发生率。结果老年联合组患者中高血压病及糖尿病的比例均高于非老年联合组（字2=10.254、9.164，P=0.001、0.002）。老年联合组的术后苏醒时间长于非老年联合组（t=1.098，P=0.009），但与老年分次组无统计学差异（t=-2.152，P=0.753）。老年联合组舒芬太尼及丙泊酚的用量均低于老年分次组和非老年联合组（t=-1.512、3.176，P=0.012、0.000）。老年联合组的生命体征异常变化发生率高于非老年联合组（字2=4.250，P=0.039），而与老年分次组之间无统计学差异（字2=0.572，P=0.449）。老年联合组其它不良反应发生率与老年分次组及非老年联合组比较均无统计学差异（字2=0.808、2.392，P=0.369、0.122）。结论一次麻醉行胃肠镜联合检查在老年患者中是可行的，但应掌握适应证，宜在麻醉内镜技术成熟以及监护、抢救设施齐全的医院开展。

Feasibility for elderly patients to undergo gastroscopy and colonoscopy examinations in one anesthetic session

Objective To evaluate the feasibility of gastroscopy and colonoscopy in one anesthetic session for elderly pa-tients. Methods Forty five elderly patients aged above 65 （elderly combination group） and 126 patients below 65 （non- elderly combination group） underwent gastroscopy and colonoscopy examinations in one anesthetic session and another 92 elderly pa-tients underwent gastroscopy and colonoscopy examinations separately （non- elderly combination group）.The underlying dis-eases,palinesthesia time,dose of analgesics,changes of vital signs and incidences of other adverse reactions were monitored and recorded during procedures. Results In elderly combination group,more patients suffered from hypertension and diabetes than in non- elderly combination group （X2=10.254, P=0.001 andX2=9.164, P=0.002）. Dosages of remifentanil and propofol in el-derly combination group were lower than those in non- elderly combination group（t=- 1.512, P=0.012 and t=3.176, P=0.000）.The palinesthesia time was longer in elderly combination group than that in non- elderly combination group （t=1.098, P=0.009）,but no difference was found between the elderly combination group and elderly non- combination group （t=- 2.152, P=0.753）.The inci-dence of abnormal vital signs in elderly combination group was higher than that in non- elderly combination group （X2=4.250, P=0.039）, but there was no difference compared to elderly non- combination group （X2=0.572, P=0.449）.There were no signifi-cant differences in incidence of other adverse reactions among groups （X2=0.808, P=0.369; X2=2.392, P=0.122）. Conclusion Gastroscopy and colonoscopy examinations in one anesthetic session are feasible for the elderly patients.