艾司氯胺酮联合右美托咪定用于药物诱导睡眠内镜检查的临床效果观察

Clinical effect observation of esketamine combined with dexmedetomidine for drug-induced sleep endoscopy

目的探讨使用艾司氯胺酮联合右美托咪定对阻塞型睡眠呼吸暂停综合征患者行药物诱导睡眠内镜检查的效果。方法选择阻塞型睡眠呼吸暂停综合征患者60例,随机分为对照组和观察组,每组30例。对照组麻醉诱导方案:右美托咪定负荷剂量1μg/kg,10 min泵入,以1μg/(kg·h)维持,同时给予丙泊酚3 mg/(kg·h)静脉恒速输注,直到患者打鼾。观察组麻醉诱导方案:右美托咪定使用方法、剂量同对照组,同时给予艾司氯胺酮1 mg/kg,以0.5 mg/(kg·h)静脉恒速输注,直到患者打鼾。当患者脑电双频指数(BIS)<75且警觉/镇静(OAA/S)评分>1分后进行睡眠内镜检查。记录患者清醒状态(T_(0))、输注右美托咪定负荷剂量10 min时(T_(1))、检查时(T_(2))、检查结束时(T_(3))的生命体征、BIS、OAA/S评分,以及用药情况(包括患者检查一次性成功率、患者检查时因体动而追加用药次数)、用药后不良事件发生情况。结果组间比较,观察组患者在T_(1)、T_(2)、T_(3)时点脉搏血氧饱和度(SpO_(2))、BIS显著高于对照组患者,在T_(2)、T_(3)时点心率、平均动脉压(MAP)显著低于对照组患者,在T_(1)、T_(2)时点OAA/S评分显著高于对照组患者(P<0.05)。组内比较,观察组患者的心率在T_(1)、T_(2)、T_(3)时点较T_(0)时点显著降低,MAP在T_(2)、T_(3)时点较T_(1)时点显著降低(P<0.05);对照组患者的SpO_(2)在T_(1)、T_(2)、T_(3)时点较T_(0)时点显著降低,心率在T_(1)时点较T_(0)时点显著降低,MAP在T_(2)时点较T_(0)时点显著升高(P<0.05)。60例患者用药后均成功完成药物诱导睡眠内镜检查,观察组患者检查一次性成功率显著高于对照组(P<0.05),因体动而追加用药的例数显著少于对照组(P<0.05)。两组患者用药后不良事件发生率差异无统计学意义(P>0.05)。结论艾司氯胺酮联合右美托咪定给药对阻塞型睡眠呼吸暂停综合征患者的呼吸抑制更轻,对血流动力学影响更小,在睡眠内镜检查过程中干预次数少,较丙泊酚更具优势。

OBJECTIVE To investigate the effects of esketamine combined with dexmedetomidine used for drug-induced sleep endoscopy in patients with obstructive sleep apnea syndrome.METHODS Totally 60 patients with obstructive sleep apnea syndrome were randomly divided into control group and observation group,with 30 cases in each group.Anesthesia induction scheme of control group included loading dose of dexmedetomidine 1μg/kg,pumped for 10 min,maintained at 1μg/(kg·h),and intravenous administration of propofol at a constant rate of 3 mg/(kg·h)until the patient snored.That of observation group included same administration route and dose of dexmedetomidine as control group,intravenous administration of esketamine 1 mg/kg at a constant rate of 0.5 mg/(kg·h)until the patient snored.Sleep endoscopy was performed when the bispectral index(BIS)was lower than 75 and the alert/sedation(OAA/S)score was higher than 1.The vital signs,BIS and OAA/S scores of patients in awake state(T_(0)),10 min load dose of dexmedetomidine infusion(T_(1)),at the time of examination(T_(2))and at the end of examination(T_(3))were recorded,as well as the patient’s medication(including the one-time success rate of examination,the number of additional drugs due to physical movement during examination),and the occurrence of adverse events after medication.RESULTS In the comparison between groups,the pulse oxygen saturation(SpO_(2))and BIS of patients in the observation group were significantly higher than those in the control group at T_(1),T_(2) and T_(3);the heart rates and mean arterial pressures(MAP)at T_(2) and T_(3) were significantly lower than those in the control group;and the OAA/S score at T_(1) and T_(2) were significantly higher than those in the control group(P<0.05).Comparison within the group,the heart rates at T_(1),T_(2) and T_(3) in the observation group were significantly lower than those at T_(0),and the MAP at T_(2) and T_(3) were significantly lower than that at T_(1)(P<0.05);in control group,compared with T_(0),SpO_(2) decreased significantly at T_(1),T_(2) and T_(3),heart rate decreased significantly at T_(1),and MAP increased significantly at T_(2)(P<0.05).Sixty patients successfully completed drug-induced sleep endoscopy after medication.The one-time success rate of examination in the observation group was significantly higher than control group(P<0.05),and the number of additional drugs due to physical movement during examination was significantly less than control group(P<0.05).There was no significant difference in the incidence of adverse events between 2 groups(P>0.05).CONCLUSIONS Esketamine combined with dexmedetomidine has less respiratory inhibition and less effect on hypoxia hemodynamics in patients with obstructive sleep apnea syndrome.It has less intervention times in the process of sleep endoscopy,and has more advantages than propofol.