盐酸羟考酮联合依托咪酯对老年患者无痛胃肠镜麻醉质量及呼吸安全的影响

Effect of Oxycodone Hydrochloride Combined with Etomidate on Anesthesia Quality and Respiratory Safety of Painless Gastrointestinal Endoscopy in Elderly Patients

摘要: 目的：比较盐酸羟考酮联合依托咪酯(OE)与舒芬太尼联合依托咪酯(SE)、咪达唑仑联合依托咪酯(ME)在老年无痛胃肠镜检查中的麻醉质量、呼吸安全及恢复特性，为老年患者提供更佳镇静–镇痛方案。方法：选取2023-07至2024-07行无痛胃肠镜的老年患者171例，随机分为OE组、SE组、ME组各57例。记录并比较三组麻醉效果优良率、膈肌活动度、低氧血症发生率、循环–呼吸动态指标、依托咪酯用量、苏醒时间、定向力恢复时间及不良反应。结果：OE组麻醉优良率(96.49%)高于SE组(91.23%)和ME组(82.46%, H = 8.74, P < 0.05)。OE组膈肌活动度最大(13.85 mm, F = 21.37, P < 0.01)，低氧血症发生率最低(5.26%)。T₁~T₃时点OE组MAP、HR、SpO₂波动最小(P < 0.01)。依托咪酯用量、苏醒及定向力恢复时间OE组均最短(P < 0.01)；总不良反应率15.79%，显著低于SE组38.60%和ME组57.89% (χ² = 22.15, P < 0.01)。结论：盐酸羟考酮联合依托咪酯可提升老年无痛胃肠镜麻醉质量，减少依托咪酯用量，维持循环–呼吸稳定，降低不良反应，兼具良好镇痛与呼吸安全性。

Abstract: Objective: To compare the anesthetic quality, respiratory safety and recovery characteristics of oxycodone hydrochloride combined with etomidate (OE) with sufentanil combined with etomidate (SE) and midazolam combined with etomidate (ME) in painless gastrointestinal endoscopy in the elderly, so as to provide a better sedation-analgesia scheme for elderly patients. Methods: 171 elderly patients who underwent painless gastrointestinal endoscopy from July 2023 to July 2024 were randomly divided into the OE group, SE group and ME group with 57 cases in each group. The excellent rate of anesthesia effect, diaphragmatic activity, incidence of hypoxemia, dynamic indexes of circulation and respiration, dosage of etomidate, recovery time, recovery time of orientation force and adverse reactions were recorded and compared among the three groups. Results: The excellent and good rate of anesthesia in the OE group (96.49%) was higher than that in the SE group (91.23%) and ME group (82.46%, H = 8.74, P < 0.05). In the OE group, diaphragm activity was the highest (13.85 mm, F = 21.37, P < 0.01), and the incidence of hypoxemia was the lowest (5.26%). At T1~T3, the fluctuation of MAP, HR and SpO₂ in the OE group was the smallest (P < 0.01). The dosage of etomidate, the recovery time of awakening and orientation were the shortest in the OE group (P < 0.01). The total adverse reaction rate was 15.79%, which was significantly lower than that of the SE group (38.60%) and ME group (57.89%) (χ² = 22.15, P < 0.01). Conclusion: Oxycodone hydrochloride combined with etomidate can improve the anesthesia quality of painless gastrointestinal endoscopy in the elderly, reduce the dosage of etomidate, maintain the stability of circulation and respiration, reduce adverse reactions, and have good analgesia and respiratory safety.