Clinical Study Of Different Doses Of Nalbuphine Combined Etomidate For Painless Gastroscopy And Colonoscopy In Elderly Patients

Objective:To observe the effect of different doses of nalbuphine combined etomidate for painless gastroscopy and colonoscopy in elderly patients,and to explore the optimal dose of nalbuphine combined etomidate for painless gastroscopy and colonoscopy in elderly patients.Methods:A total of 120 elderly patients,with no restriction on gender,aged 65-75years old,ASA GRADEⅠorⅡ,were randomly divided into four groups with30 patients in each group:nalbuphine 0.05 mg/kg group（Group N1）,nalbuphine 0.075 mg/kg group（Group N2）,nalbuphine 0.1 mg/kg group（Group N3）and nalbuphine 0.125 mg/kg group（Group N4）.Patients in the four groups were slowly injected with nalbuphine 0.05,0.075,0.1 and 0.125mg/kg intravenously,respectively,and were all injected with etomidate 0.2mg/kg intravenously 3min later.Gastroscopy was performed until Modified Observer’s Assessment of Alertness/Sedation Scale（MOAA/S）score≤3points.Etomidate 0.1 mg/kg was added when MOAA/S score was higher than 3 or subjects had coughing and body movement.The success cases of first induction,the number of examples with Modified Behavioral Pain Scale score for non-intubated patients（BPS-NI）score>5 points,total amount of etomidate,time of gastroscopy and colonoscopy,recovery time,and standard time of discharge were recorded.Mean arterial pressure（MAP）,heart rate（HR）,blood oxygen saturation（Sp O₂）and respiratory rate（RR）of the four groups were recorded before anesthesia（T₀）,1min after induction（T₁）,gastroscope（T₂）,colonoscope through splenic flexure（T₃）and colonoscope through hepatic flexure（T₄）.The incidence of adverse events,patient satisfaction,endoscopist satisfaction and anesthesiologist satisfaction were recorded.Results:1.Compared with group N1 and N2,the success rate of first induction significantly increased in group N3 and N4（P<0.05）,the total dosage of etomidate and the incidence of BPS-NI score>5 points decreased（P<0.05）,and the standard time of discharge was also significantly shortened（P<0.05）.There was no significant difference in recovery time（P>0.05）.2.Compared with T₀,MAP in group N2,group N3and N4 decreased significantly at T₁（P<0.05）,MAP in group N3 and N4 decreased significantly at T₂-T₄（P<0.05）,Sp O₂ in group N3 and N4 increased at T₁（P<0.05）,and Sp O₂ in group N2 decreased at T₂（P<0.05）,Sp O₂ in four groups was decreased at T₃（P<0.05）,and Sp O₂ was decreased in group N1,N2 and N3 at T₄（P<0.05）.3.The incidence of cough movement in group N1 and N2 had a significant increase compared to that in group N4（P<0.05）,the incidence of cough movement in group N1 had a significant increase compared to that in group N3（P<0.05）.The incidence of dizziness in group N1 and N2 had a significant decrease compared to that in group N4（P<0.05）.There was no statistically significant difference in the incidence of muscle tremor,respiratory depression,sinus bradycardia,hypotension,nausea and vomiting（P>0.05）.4.Compared with group N1 and N2,the endoscopist satisfaction rate and anesthesiologist satisfaction rate in group N3 had a significant increase（P<0.05）,the endoscopist satisfaction rate had a significant increase in group N4（P<0.05）.The anesthesiologist satisfaction rate in group N4 had a significant decrease compared to that in group N3（P<0.05）.Conclusions:Nalbuphine combined with etomidate is safe and effective for painless gastroscopy and colonoscopy in elderly patients.The optimal dosage of nalbuphine is 0.1 mg/kg,which has an ideal sedative and analgesic effect and decreases the dosage of etomidate and incidence of adverse events.