小剂量氯胺酮复合丙泊酚、瑞芬太尼用于无痛胃镜检查的效果及安全性

Clinical efficiency and safety of intravenous small-dose ketamine combined with remifentanil and propfol for painless gastroscopy

目的探讨氯胺酮复合丙泊酚、瑞芬太尼在无痛胃镜检查中的临床效果。方法将42例ASAⅠ～Ⅱ级患者随机分成两组,均行胃镜检查A组采用瑞芬太尼丙泊酚麻醉,B组采用氯胺酮、瑞芬太尼麻醉。观察两组丙泊酚使用剂量,术中OAA/S评分,苏醒时间及并发症。结果丙泊酚首次剂量、总剂量A组>B组(P<0.05),两组OAA/S评分无明显差异;两组苏醒时间(出镜—呼之睁眼)无显著差异;两组窦缓(HR<60次/min)、注射痛发生率A组>B组(P<0.05),低氧血症(SpO2<90%)发生率无明显差异,两组均无术中知晓、喉痉挛、恢复期兴奋、烦躁。结论瑞芬太尼加丙泊酚麻醉可明显减慢心率,复合小剂量氯胺酮能减少丙泊酚的首次剂量和总量,不影响麻醉效果、苏醒和恢复,并明显降低窦缓和诱导期注射痛的发生,是无痛胃镜检查术较为适用的麻醉方法。

Objective To investigate the clinical efficiency and safety of intravenous ketamine combined with remifentanil and propfol for painless gastroscopy. Methods 42 ASA Ⅰ - Ⅱ adult patients undergoing gastroscopy were randomly divided into the observed group and the control group with 21 patients in each . Both groups were treated with propfol and remifentanil, and the observed group combined with small-dose ketamine. The total dose of propfol, OAA/S score , recovery time and comphcafions were recorded. Results The initial , total dose and incidence of sinus bradycardia, injection pain of propfol in the observed group were significantly lower than those in the control group（ P 〈0.05 ）. There were no significant difference in the operative duration, OAA/S score and recovery time between the two groups. Conclusion Compared with application of remifentanil, ketamine, combined with remifen ＇tanil can be used more effectively and safely in spainless gastroscopy.