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| 小剂量艾司氯胺酮预防无痛人工流产患者丙泊酚注射痛的效果 |
| Effect of low-does of esketamine on propofol injection pain in patients undergoing painless abortion |
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| DOI：10.12089/jca.2022.12.007 |
| 中文关键词: 艾司氯胺酮 丙泊酚 注射痛 人工流产 |
| 英文关键词: Esketamine Propofol Injection pain Induced abortion |
| 基金项目:宁波市公益类科技项目（2019C50090） |
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| 摘要点击次数: 963 |
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| 中文摘要: |
目的 探讨小剂量艾司氯胺酮预防无痛人工流产患者丙泊酚注射痛（PIP）的效果。
方法 选择行无痛人流患者198例，年龄18～50岁，BMI 19～26 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为三组：生理盐水组（C组）、利多卡因组（L组）和艾司氯胺酮组（E组），每组66例。C组静脉注射等体积生理盐水5 ml，L组静脉注射利多卡因0.5 mg/kg，E组静脉注射艾司氯胺酮0.15 mg/kg。每组静脉注射相应药物60 s后，以0.2 ml/s的速度静脉注射丙泊酚2 mg/kg。采用Ambesh四分法评价PIP发生情况。记录麻醉前、手术开始前和手术结束时的HR、SBP、DBP。记录术中丙泊酚总用量、麻醉时间、手术时间、苏醒时间。记录去氧肾上腺素和阿托品使用情况。记录术中低血压、低氧血症、心动过缓、谵妄、恶心呕吐、体动等不良反应发生情况。
结果 与C组比较，L组和E组中重度疼痛和PIP发生率明显降低（P＜0.05）。与L组比较，E组轻度疼痛和PIP发生率明显降低（P＜0.05）。与E组比较，手术开始前C组和L组SBP和DBP明显降低，术中丙泊酚总用量明显增多，麻醉时间和苏醒时间明显延长，低氧血症及需托下颌的发生率均明显升高（P＜0.05）。三组患者术中低血压、心动过缓、恶心呕吐、谵妄等不良反应发生率差异无统计学意义。
结论 小剂量艾司氯胺酮（0.15 mg/kg）可有效抑制无痛人工流产术中丙泊酚注射痛，维持血流动力学稳定并降低不良反应发生率，可安全用于无痛人工流产术。 |
| 英文摘要: |
Objective To investigate the effect of low-dose of esketamine on propofol injection pain (PIP) in patients undergoing painless abortion.
Methods A total of 198 patients undergoing painless abortion, aged 18-50 years, BMI 19-26 kg/m2, ASA physical status Ⅰ or Ⅱ, were divided into three groups using a random number table method: normal saline group (group C), lidocaine group (group L) and esketamine group (group E), 66 patients in each group. Group C was given 5 ml of the same volume of normal saline, group L was given introvenous infusion of lidocaine 0.5 mg/kg, and group E was given esketamine 0.15 mg/kg. After 60 seconds of pretreatment in each group, propofol 2 mg/kg was injected intravenously at a rate of 0.2 ml/s. The occurence of PIP in each group was evaluated by Ambesh method. HR, SBP, DBP were recorded respectively before anesthesia induction, before surgery and immediately after the end of surgery. The total amount of propofol, anesthesia time, operation time, recovery time and the usages of norepinephrine and atropine were recorded. The occurrence of adverse events such as hypotension, hypoxemia, bradycardia, delirium, body movement, nausea and vomiting were also recorded.
Results Compared with group C, the incidence of PIP and moderate and severe pain in groups L and E were significantly decreased. Compared with group L, the incidence of mild pain and PIP in group E were significantly lower than in group L (P < 0.05). Compared with group E, the SBP and DBP were significantly lower before surgery, the total amount of propofol was significantly increased, the anesthetic time and recovery time were significantly prolonged, and the rate of hypoxemia cases and mandibular support cases were significantly increased in groups C and L (P < 0.05). There were no significant differences in intraoperative adverse events such as hypotension, bradycardia, nausea, vomiting and delirium among the three groups.
Conclusion Low-dose of esketamine (0.15 mg/kg) can effectively alleviate PIP during painless abortion, maintain hemodynamic stability and reduce the occurrence of adverse events, which can be safely used in painless abortion. |
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