氯胺酮复合异丙酚镇静用于老年男性膀胱镜检查的临床研究

Ketamine and propofol in combination for sedation during cystoscope in elderly male patients

目的探讨小剂量氯胺酮复合异丙酚靶控镇静用于老年男性患者硬性膀胱镜检查的安全性和有效性。方法45例ASAI～Ⅲ级行硬性膀胱镜检查的老年男性患者,随机分为A组:尿道内灌注2％利多卡因凝胶;B组:尿道内灌注2％利多卡因凝胶+异丙酚靶控镇静;C组:尿道内灌注2％利多卡因凝胶+小剂量氯胺酮+异丙酚靶控镇静。每组15例。记录3组术前、局麻、置镜、检查、术毕时的平均动脉压(MAP)、心率、脉搏血氧饱和度(SPO2),B、C两组警觉／镇静评分(OAA／S)3分时的效应室浓度、苏醒时间,术毕根据视觉模拟评分(VAS)进行疼痛评估。结果A组术中置镜时MAP、心率与术前比较差异有统计学意义(P<0．05);B组术中各时点MAP、心率与术前比较,差异有统计学意义(P<0．05);C组术毕MAP、心率与术前比较,差异有统计学意义(P<0．05)。B、C两组OAA／S评分3分时效应室浓度分别为(1．3±0．2)μg／ml和(1．6±0．2)μg／ml,差异有统计学意义(P<0．05)。B、C两组苏醒时间分别为(3．3±1．2)min和(3．0±0．9)min,差异无统计学意义(P>0．05)。术毕疼痛评估:A组轻度疼痛10例,中度疼痛4例,重度疼痛1例;B、C两组患者均为无痛,并对手术过程无记忆。结论小剂量氯胺酮复合异丙酚靶控镇静用于老年男性患者硬性膀胱镜检查具有良好的镇痛、镇静及顺行性遗忘作用,术中血流动力学稳定,术后苏醒迅速,对老年患者较单独使用异丙酚更加安全、有效。

Objective To study the safety and efficacy of target-controlled infusion （TCI） sedation with low dose ketamine and propofol during rigid cystoscopy in elderly male patients Methods Forty-five elderly male patients with Ⅰ-Ⅲgrade of the American Society of Anesthesiologists （ASA）rigid cystoscopy examination were divided into 3 groups randomly： group A, 2% lydocaine gel was filled in urethra, n= 15; group B, 2% lydocaine gel filled with propofol TCI sedation, n= 15 ; group C, 2 % lydocaine gel filled with combined ketamine and propofol TCI sedation, n= 15. The mean artery pressure（MAP）, heart rate（FIR）, pulse oxygen saturation （SPO2）were measured at 5 time points： preoperation, during local anesthesia, inserting the scope, during testing and the end of testing. The concentration of effect room, wake time when alertness and calm grading （OAA/S）was 3 scores in B and C groups and visual analogue scale（VAS） score of pain after operation were detected. Results The MAP and FIR at the time point of inserting the scope in group A had significant difference, compared with preoperation（P〈0.05） ; MAP and FIR at each time points during operation had significant difference, compared with preoperation in group B（P〈0.05）; The MAP and FIR had significant difference at the end of operation compared with preoperation in group C （ P〈 0.05）. Significant difference was found between B[ （ 1.3±0.2） μg/ml] and C groups[ （ 1.6±0.2）μg/ ml] （P〈0.05）in the concentration of effect room when OAA/S score was 3. No significant difference in awakening time was found between groups B[（3.3±1.2）min] and C[（3.00±0. 9）min] （P〉0.05） . In group A,10 cases pain VAS score were light pain, 4 moderate and 1 severe. In group B and C,no pain and no memory of the operation were reported. Conclusions TCI sedation with low dose of ketamine and propofol in elderly male patients under rigid cystoscope has good effects on sedation, analgesia and anterograde amnesia. The hemodynamics is stable and wake time is short.