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| 亚麻醉剂量艾司氯胺酮复合丙泊酚应用于无痛胃肠镜检查的效果 |
| Effect of subanesthetic dose of esketamine combined with propofol on painless gastroenterological endoscopy |
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| DOI：10.12089/jca.2022.02.007 |
| 中文关键词: 艾司氯胺酮 丙泊酚 亚麻醉剂量 无痛胃肠镜 |
| 英文关键词: Esketamine Propofol Subanesthetic dose Painless gastroenterological endoscopy |
| 基金项目: |
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| 摘要点击次数: 2932 |
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| 中文摘要: |
目的 观察亚麻醉剂量艾司氯胺酮复合丙泊酚应用于无痛胃肠镜检查的效果。
方法 选择2021年2—3月行无痛胃肠镜检查的患者100例，男53例，女47例，年龄18～74岁，BMI 18～28 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：亚麻醉剂量艾司氯胺酮复合丙泊酚组（E组）和单纯丙泊酚组（P组），每组50例。无痛胃肠镜检查时E组缓慢静脉注射艾司氯胺酮液0.25 mg/kg，后缓慢静注丙泊酚2.0～2.5 mg/kg进行麻醉诱导，静脉泵注丙泊酚4～6 mg·kg-1·h-1进行麻醉维持；P组单纯缓慢静注丙泊酚2.0～2.5 mg/kg进行麻醉诱导，静脉泵注丙泊酚4～6 mg·kg-1·h-1进行麻醉维持，两组均在患者入睡且睫毛反射消失后开始检查，若有呛咳或明显体动反应，则追加丙泊酚0.5～1.0 mg/kg。记录麻醉诱导前即刻、进镜前即刻、到达检查终点时及苏醒时的HR、SBP、DBP和SpO2。记录麻醉起效时间、丙泊酚追加总量、丙泊酚追加例数、苏醒时间、苏醒质量（PADSS评分）、离开复苏室时间、苏醒时及苏醒后30 min静息时VAS疼痛评分。记录术后眩晕、呼吸抑制、呛咳、体动以及丙泊酚注射痛等不良反应发生情况。
结果 与麻醉诱导前即刻比较，进镜前即刻、到达检查终点时两组HR明显减慢（P<0.05），SBP、DBP和SpO2明显降低（P<0.05）。与P组比较，E组进镜前即刻、到达检查终点时HR明显加快(P<0.05)，SBP、DBP和SpO2明显升高（P<0.05），麻醉起效时间明显缩短（P<0.05），丙泊酚追加总量明显减少（P<0.05），苏醒时及苏醒后30 min静息时VAS疼痛评分明显降低（P<0.05），丙泊酚追加率、呼吸抑制、呛咳、体动、丙泊酚注射痛发生率均明显降低（P<0.05）。两组苏醒时间、PADSS评分、离开复苏室时间及术后眩晕发生率差异无统计学意义。
结论 亚麻醉剂量艾司氯胺酮复合丙泊酚用于无痛胃肠镜检查，可以维持血流动力学稳定、减少丙泊酚用量、降低不良反应发生率，并提供有效的镇静镇痛。 |
| 英文摘要: |
Objective To observe the effect of subanesthetic dose of esketamine combined with propofol in painless gastroenterological endoscopy.
Methods A total of 100 patients undergoing painless gastroenterological endoscopy, were selected from February 2021 to March 2021, 53 males and 47 females, aged 18-74 years, BMI 18-28 kg/m2 , ASA physical status Ⅰ or Ⅱ. According to random number table method, patients were divided into two groups: subanesthetic dose of esketamine combined with propofol group (group E) and propofol group (group P), 50 patients in each group. During painless gastroenterological endoscopy, group E was given esketamine 0.25 mg/kg intravenously followed by propofol 2.0-2.5 mg/kg intravenously, and the maintenance dose of propofol was 4-6 mg·kg-1·h-1, group P was given propofol 2.0-2.5 mg/kg intravenously, and the maintenance dose of propofol was 4-6 mg·kg-1·h-1. Both groups began to check after the patient fell asleep and the eyelash reflex disappeared. When necessary (cough or movement), additional propofol 0.5-1.0 mg/kg was added to enhance and maintain anesthesia. The HR, SBP, DBP, and SpO2 were recorded immediately before induction, immediately before inserting, gastroscopy end-point and after procedure. Anesthesia onset time, total additional dosage of propofol, additional cases of propofol, awakening time, quality of awakening (PADSS score), the time leaving PACU, VAS score of awaking time and 30 minutes after awaking at rest were recorded. Postoperative vertigo, respiratory depression, cough, body movement and the incidence of propofol injection pain were also recorded.
Results Compared with the time immediately before induction, HR, SBP, DBP, and SpO2 of the two groups immediately before inserting and gastroscopy end-point were significantly lower (P < 0.05). Compared with group P, HR, SBP, DBP, and SpO2 were significantly increased immediately before inserting and gastroscopy end point in group E (P < 0.05). The anesthesia onset time was significantly shortened (P < 0.05), total additional dosage of propofol, additional cases of propofol, respiratory depression, cough, body movement, propofol injection pain, postoperative VAS score of awaking time and 30 minutes after awaking at rest in group E were significantly lower (P < 0.05). There were no significant differences in awakening time, quality of awakening (PADSS score), the time leaving PACU, and the incidence of postoperative vertigo between the two groups.
Conclusion The subanesthetic dose of esketamine combined with propofol can maintain hemodynamic stability, reduce the dosage of propofol and reduce adverse reactions, and provide effective sedation and analgesia． |
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