亚麻醉剂量氯胺酮辅助丙泊酚在无痛胃肠镜诊疗中的应用

Application of propofol assisted with sub-anesthesia doses of ketamine in painless gastrointestinal endoscopy treatment

目的探讨亚麻醉剂量氯胺酮辅助丙泊酚用于无痛胃肠镜诊疗的安全性及临床麻醉效果。方法选择我院行胃肠镜诊疗患者80例,ASAⅠ或Ⅱ级。按随机数字表法分为氯胺酮组(KP组)和丙泊酚组(P组),每组40例。观察记录两组患者麻醉诱导前即刻(T_0)、入镜前即刻(T_1)、内镜到达检查终点时(T_2)、内镜退出时(T_3)及苏醒时(T_4)的SBP、DBP、HR、SpO_2;记录诊疗时间、意识消失及苏醒时间、丙泊酚消耗剂量及丙泊酚注射痛发生情况;记录各组患者呛咳、体动、呼吸暂停等不良反应的发生情况。结果两组患者T_1、T_2时SBP、DBP、HR和SpO_2明显低于T_0时(P<0.05);T_1、T_2时KP组SBP、DBP、HR和SpO_2明显高于P组(P<0.05);KP组患者意识消失时间、丙泊酚消耗量、丙泊酚注射痛、呛咳、体动的发生率均显著少于P组(P<0.05)。结论亚麻醉剂量氯胺酮辅助丙泊酚用于无痛胃肠镜诊疗,能显著减少丙泊酚的用量及注射痛;减少循环波动及呼吸抑制等不良反应发生,麻醉效果优于单独应用丙泊酚。

Objective To investigate the safety and clinical anesthesia effect of propofol assisted with sub-anesthesia doses of ketamine in painless gastrointestinal endoscopy treatment. Methods 80 patients with ASA Ⅰ or Ⅲ who were given gastrointestinal endoscopy treatment were chosen. The patients were divided into ketamine group （KP group） and propofol group（P group） according to the random number table method, with 40 cases in each group. The SBP,DBP,HR and SpO： of the two groups were observed and recorded immediately before anesthesia induction（T0）, immediately before underdoing endoseopy（T1）,when the endoscope reached the end of the inspection（T2）, when the endoscopy withdrawed （T3） and when awake（T4）.The time of treatment, consciousness loss and awakening time, propofol consumption dose and the occurrence of propofol injection pain were recorded. The incidence of adverse events such as cough, body motion and apnea in each group were recorded. Results The SBP, DBP, HR and SpO2 at T1 and T2 in the two groups were sig- nificantly lower in than those at To （P〈0.05）. The SBP, DBP, HR and SpO2 in KP group were significantly higher than those in P group at T1 and T2 （P〈0.05）. The incidences of the time of consciousness loss, propofol consumption amount, propofol injection pain, cough and body movement were significantly lower in KP group than in those in P group （P〈 0.05）. Conclusion Propofol assisted with sub-anesthesia doses of ketamine for the treatment of painless gastrointestinal endoscopy can significantly reduce the amount of propofol and injection pain, and can reduce the occurrence of adverse reactions such as circulatory fluctuations and respiratory depression, and the anesthetic effect of which is better than that of propofol alone.