艾司氯胺酮联合丙泊酚用于无痛支气管镜检查麻醉的临床应用

Clinical application of esketamine combined with propofol in painless bronchoscopy anesthesia

目的观察艾司氯胺酮联合丙泊酚用于无痛支气管镜检查麻醉的安全性及有效性。方法选择2021年1月—2021年3月在首都医科大学附属北京胸科医院接受无痛支气管镜检查的患者62例,按随机数字表法分为对照组(30例)和观察组(32例)。对照组采用舒芬太尼联合丙泊酚静脉麻醉,观察组采用艾司氯胺酮联合丙泊酚静脉麻醉。记录两组患者麻醉前(T_(0))、麻醉后(T_(1))、气管镜插入声门时(T_(2))、检查过程中(T_(3))的SBP、DBP、心率、SpO_(2)、苏醒时间、Steward苏醒评分及不良反应发生率。结果两组患者T_(0)时SBP、DBP、心率、SpO_(2)比较,差异无统计学意义(P>0.05)。观察组T_(1)、T_(2)、T_(3)时SpO_(2)均高于对照组(P<0.05);观察组T_(1)、T_(3)时SBP、DBP、心率均高于对照组,T_(2)时SBP、DBP、心率均低于对照组(P<0.05)。观察组苏醒时间短于对照组(P<0.05)。两组患者Steward苏醒评分及不良反应(头晕、恶心)发生率比较,差异无统计学意义(P>0.05)。结论艾司氯胺酮联合丙泊酚用于无痛支气管镜检查麻醉术中循环呼吸平稳、术后苏醒快、可控性好,具有较高的临床应用价值。

Objective To evaluate the safety and effectiveness of esketamine combined with propofol in painless bronchoscopy anesthesia.Methods A total of 62 patients who underwent painless bronchoscopy in Beijing Chest Hospital Affiliated to Capital Medical University from January to March 2021 were enrolled.According to the random number table method,they were divided into two groups:a control group(n=30)and an observation group(n=32).The control group was anesthetized with propofol combined with sufentanil,while the observation group was anesthetized with esketamine combined with propofol.Then,their systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate,pulse oxygen saturation(SpO_(2))and recovery time,Steward recovery score and the incidence of adverse reactions were recorded before anesthesia(T_(0)),after anesthesia(T_(1)),when the bronchoscope was inserted into the glottis(T_(2)),and during the examination(T_(3)).Results There was no significant difference between the two groups in SBP,DBP,heart rate,and SpO_(2) at T_(0)(P>0.05).The observation group presented increases in SpO_(2) at T_(1),T_(2),and T_(3) compared with the control group(P<0.05).The observation group showed increases in SBP,DBP,heart rate at T_(1) and T_(3),as well as decreases in SBP,DBP,and heart rate at T_(2),compared with the control group(P<0.05).The recovery time was shorter in the observation group than that of the control group(P<0.05).There was no significant difference between the two groups in Steward recovery score and the incidence of adverse reactions(nausea and vomiting)(P>0.05).Conclusions The use of esketamine combined with propofol in painless bronchoscopy anesthesia has smooth circulation and breathing,rapid postoperative recovery,and good controllability,with high clinical application value.