无痛胃肠镜麻醉：药物应用、方案优化与安全管理研究综述

Research Review on Anesthesia for Painless Gastrointestinal Endoscopy: Drug Application, Regimen Optimization and Safety Management

摘要: 随着人口老龄化进程的加快，老年人群胃肠疾病的发病率逐年攀升，胃肠镜检查及治疗已成为老年胃肠疾病诊断与干预的重要手段。麻醉安全是老年胃肠镜诊疗的关键环节，丙泊酚与依托咪酯均为临床常用静脉麻醉药，二者联合应用在老年胃肠镜麻醉中已得到广泛探索。给药速度作为麻醉给药的核心参数，直接影响麻醉诱导质量、血流动力学稳定性及不良反应发生率，对老年患者的麻醉安全性具有重要影响。近年来，随着新型镇静药物问世、联合用药理念普及及特殊人群麻醉管理精细化，该领域临床研究与实践持续迭代。本文基于现有文献，从单一药物应用、联合麻醉方案、特殊人群管理、不良反应防控等维度，对无痛胃肠镜麻醉研究现状进行系统述评，梳理研究成果、剖析现存问题，并展望未来发展方向，为临床麻醉决策与后续研究提供理论参考。

Abstract: With the accelerating population aging, the incidence of gastrointestinal diseases among the elderly has increased year by year. Gastrointestinal endoscopy examination and therapy have become vital approaches for the diagnosis and intervention of geriatric gastrointestinal disorders. Anesthetic safety constitutes a critical component of gastrointestinal endoscopic procedures in elderly patients. Both propofol and etomidate are commonly-used intravenous anesthetics in clinical practice, and their combined administration has been extensively investigated for anesthesia in elderly gastrointestinal endoscopy. As a core parameter of anesthetic medication, infusion rate directly determines the quality of anesthetic induction, hemodynamic stability and the incidence of adverse reactions, exerting a significant impact on anesthetic safety for elderly patients. In recent years, clinical research and practice in this field keep evolving alongside the advent of novel sedative agents, the popularization of combined-drug strategies, and refined anesthetic management for special populations. Based on available literature, this paper systematically reviews current research on anesthesia for painless gastrointestinal endoscopy from the perspectives of single-drug application, combined anesthetic regimens, management of special populations, and prevention and control of adverse reactions. It summarizes research findings, analyzes existing limitations, and prospects future development directions, so as to provide theoretical references for clinical anesthetic decision-making and further studies.