艾司氯胺酮复合异丙酚在乳腺微创旋切术中的麻醉效果

Application of Esketamine combined with Propofol in the minimally invasive surgery of benign breast tumors

目的探讨艾司氯胺酮复合异丙酚用于乳腺微创旋切术的麻醉效果。方法选择行乳腺微创旋切术的患者60例,随机分为观察组和对照组,每组30例。观察组静脉注射艾司氯胺酮0.4 mg/kg、异丙酚1.5 mg/kg,对照组静脉注射瑞芬太尼2μg/kg、异丙酚1.5 mg/kg。记录手术时间、患者苏醒时间、术中异丙酚追加例数和术后补救镇痛剂例数,采用数字模拟评分法(NRS)评估患者苏醒即刻、10 min和30 min的疼痛程度。记录不良反应发生情况。结果观察组与对照组手术时间[观察组:(5.7±3.6)min;对照组:(6.1±2.9)min]和苏醒时间[观察组:(4.2±1.8)min;对照组:(3.9±2.3)min]比较,差异无统计学意义。观察组苏醒即刻、10 min、30 min的NRS评分[(2.02±0.43)分、(2.64±0.47)分、(2.31±0.42)分]明显低于对照组[(3.52±0.51)分、(4.45±0.54)分、(3.97±0.63)分](P<0.05)。观察组和对照组异丙酚追加例数(3例比12例)和术后补救镇痛例数(0例比8例)比较差异有统计学意义(P<0.05)。两组患者的手术时间和苏醒时间比较差异无统计学意义(P>0.05)。观察组心动过缓的发生率明显低于对照组(2例比12例),而术后头晕的发生率明显高于对照组(18例比5例,P<0.05),总体不良反应发生例数差异无统计学意义(27例比例)。结论艾司氯胺酮复合异丙酚可以提高乳腺微创旋切术患者麻醉及术后镇痛效果,且不良反应轻微。

Objective To observe the anesthetic effect of Esketamine combined with Propofol in minimally invasive surgery of benign breast tumors.Methods Sixty patients who underwent minimally invasive excision of benign breast tumors were randomly divided into two groups(n=30):Esketamine combined with Propofol group(observation group)and remifentanil combined with Propofol group(control group),with 30 cases in each group.The observation group was intravenously injected with Esketamine 0.4 mg/kg and propofol 1.5 mg/kg,and control group was intravenously injected with remifentanil 2μg/kg and Propofol 1.5 mg/kg.The operation time and recovery time were recorded.The number of people who needed additional intraoperative propofol were recorded.The number of people who required additional analgesics after surgery were recorded.The degree of pain was evaluated using Numeric rating scale(NRS)at 0,10,30 minutes after the patients recovery.The occurrence of adverse reactions was recorded.Results There were no signifficant difference between the operation time[observation group:(5.7±3.6)min;control group:(6.1±2.9)min]and recovery time[observation group:(4.2±1.8)min;control group:(3.9±2.3)min]in two group.The NRS score of the observation group(2.02±0.43、2.64±0.47、2.31±0.42)was significantly lower than that of the observation group(3.52±0.51、4.45±0.54、3.97±0.63)at 0,10,30 minutes after recovery(P<0.05).There were statistically significant differences in the number of additional cases of propofol(3 vs.12)and the number of postoperative relief analgesia(0 case vs.8 cases)between the observation group and the control group(P<0.05).There were no significant differences in operation time and recovery time between the two groups.The incidence of bradycardia in the observation group was significantly lower than that in the control group(2 cases vs.12 cases),and the incidence of postoperative vertigo was significantly higher in the observation group than that in the control group(18 cases vs.5 cases,P<0.05)and there was no significant difference in the number of overall adverse reactions(27 cases).Conclusion Esketamine combined with propofol can improve the anesthesia and postoperative analgesic effect of patients undergoing minimally invasive benign breast surgery,and the adverse reactions are mild.