文章摘要
艾司氯胺酮复合丙泊酚在宫腔镜检查术中的应用
Application of esketamine combined with propofol in hysteroscopy
  
DOI：10.12089/jca.2021.07.007
中文关键词: 艾司氯胺酮  宫腔镜  丙泊酚
英文关键词: Esketamine  Hysteroscopy  Propofol
基金项目:
作者单位E-mail
钱夏丽 210004,南京医科大学附属妇产医院（南京市妇幼保健院）麻醉科  
夏凡 210004,南京医科大学附属妇产医院（南京市妇幼保健院）麻醉科  
沈晓凤 210004,南京医科大学附属妇产医院（南京市妇幼保健院）麻醉科  
徐世琴 210004,南京医科大学附属妇产医院（南京市妇幼保健院）麻醉科 xusqnj@126.com 
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中文摘要:
      
目的 观察艾司氯胺酮复合丙泊酚用于宫腔镜检查术的麻醉效果。
方法 选择择期行无痛宫腔镜检查术的患者80例，年龄20～60岁，BMI 18～28 kg/m2，ASA Ⅰ或Ⅱ级，随机分为两组：艾司氯胺酮复合丙泊酚组（A组）和单纯丙泊酚组（B组），每组40例。A组静脉缓慢推注艾司氯胺酮0.5 mg/kg、丙泊酚1 mg/kg，B组缓慢推注丙泊酚2.5 mg/kg。记录苏醒时间、术中丙泊酚追加例数，采用数字模拟评分法（NRS）评价苏醒后5、15、30 min的宫缩痛程度。记录围术期不良反应的发生情况。
结果 A组麻醉苏醒时间明显短于B组，丙泊酚追加例数明显少于B组（P＜0.05）。A组苏醒后5、15、30 min的NRS评分明显低于B组（P＜0.05）。A组术中丙泊酚注射痛、托下颌、体动、心动过缓发生率明显低于B组（P＜0.05）。A组术后头晕的发生率明显高于B组[25例（62%） vs 7例（18%），P＜0.05]。
结论 艾司氯胺酮复合丙泊酚可以提高宫腔镜检查术患者的麻醉及术后镇痛效果，减少术中丙泊酚用量，且不良反应轻微。
英文摘要:
      
Objective To observe the anesthetic effect of esketamine combined with propofol in hysteroscopy.
Methods Eighty patients, aged 20-60 years, BMI 18-28 kg/m2, ASA physical status Ⅰ or Ⅱ, who underwent selective painless hysteroscopy were randomized into 2 groups, 40 patients in each group. In group A, esketamine 0.5 mg/kg and propofol 1 mg/kg were slowly injected intravenously; while in group B, propofol 2.5 mg/kg was slowly injected alone intravenously. The length of recovery and the number of people who needed additional intraoperative propofol were recorded. The degree of uterine cramping pain was evaluated at 5, 15, 30 minutes after the patient woke up using Numeric rating scale (NRS). Moreover, the occurrences of perioperative adverse reactions were carefully recorded and compared.
Results Compared with group B, the recovery time was shorter, fewer people needed additional intraoperative propofol in group A (P < 0.05). The degree of uterine cramping pain at 5, 15, 30 minutes after the patient woke up in group A was significantly lower than that in group B (P < 0.05). Meanwhile, the incidences of propofol injection pain, jaw-lift, body movement and bradycardia in group A were significantly lower (P < 0.05). Furthermore, 25 patients occurred postoperative vertigo in group A, while 7 patients in group B (62% vs 18%, P < 0.05).
Conclusion Esketamine combined with propofol can improve the anesthesia and postoperative analgesic effect of patients undergoing hysteroscopy, reduce the amount of intraoperative propofol, and the adverse reactions are mild.
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