右美托咪定、丙泊酚联合小剂量艾司氯胺酮在宫腔镜手术中的临床应用

Clinical effect of dexmedetomidine and propofol combined with a low dose of esketamine in hysteroscopy

目的探讨右美托咪定、丙泊酚联合小剂量艾司氯胺酮在宫腔镜手术中的临床应用效果。方法选择2021年1月至12月在威海市立医院接受妇科宫腔镜手术的96例女性患者,年龄18~60岁,按随机数字表法将其分为对照组(48例)和研究组(48例)。对照组采取右美托咪定联合丙泊酚全凭静脉麻醉,研究组采取右美托咪定、丙泊酚联合小剂量艾司氯胺酮全凭静脉麻醉。观察并记录入室(T0)、Ramsay评分达到5分时(T1)、扩宫颈时(T2)、苏醒时(T3)的平均动脉压(MAP)、心率(HR)和脉搏氧饱和度(SpO_(2)),记录术中丙泊酚的用量、术后苏醒时间以及围术期不良反应的发生情况。采用独立样本t检验、重复测量的方差分析、χ^(2)检验。结果研究组T1时MAP、HR和SpO_(2)明显高于对照组[(68.5±8.9)mmHg比(59.3±7.5)mmHg(1 mmHg=0.133 kPa)、(75.3±6.4)次/min比(60.5±7.7)次/min、(98.5±0.6)%比(95.5±1.1)%,均P<0.05];T2时MAP和HR低于对照组[(73.8±10.1)mmHg比(83.5±11.8)mmHg、(76.1±9.7)次/min比(89.7±8.7)次/min,均P<0.05];对照组术中丙泊酚的用量大于研究组[(269.2±29.2)mg比(216.7±25.2)mg,t=9.430,P<0.001];苏醒时间明显长于研究组[(6.9±1.3)min比(5.5±1.2)min,t=5.482,P<0.001];术中对照组体动反应、呼吸抑制发生率均高于研究组[25.0%(12/48)比4.2%(2/48)、31.2%(15/48)比6.2%(3/48),均P<0.05];两组术后恶心、呕吐、眩晕的发生率差异均无统计学意义(均P>0.05)。结论右美托咪定、丙泊酚联合小剂量艾司氯胺酮用于妇科宫腔镜手术麻醉,术中循环呼吸平稳,术后苏醒快,可控性好,不良反应发生率低,具有较高的临床应用价值。

Objective To investigate clinical effect of dexmedetomidine,propofol,and a low dose of esmketamine in hysteroscopy.Methods Niety-six female patients who were 18-60 years old and underwent gynecological hysteroscopic surgery in Weihai Municipal Hospital from January to December 2021 were selected,were divided into a control group(48 cases)and a study group(48 cases)by the random number table method.The control group was anesthetized with dexmedetomidine and propofol,and the study group with dexmedetomidine,propofol,and a low dose of esmketamine.The mean arterial pressures(MAP),heart rates(HR),and pulse oxygen saturations(SpO_(2))when entering the room(T0),when the Ramsay score reached 5(T1),at cervical dilation(T2),and when they woke up(T4)were observed and recorded.The dosages of propofol during operation,the recovery times after operation,and the occurrences of perioperative adverse reactions were recorded.The independent-sample t test,repeated measure ANOVA,and χ^(2) test were applied.Results At T1,theMAP,HR,and SpO_(2) in the study group were obviously higher than those in the control group[(68.5±8.9)mmHg(1mmHg=0.133 kPa)vs.(59.3±7.5)mmHg,(75.3±6.4)beats/min vs.(60.5±7.7)beats/min,and(98.5±0.6)%vs.(95.5±1.1)%;all P<0.05];at T2,the MAP and HR in the study groupwere lower than those in the control group[(73.8±10.1)mmHg vs.(83.5±11.8)mmHg and(76.1±9.7)beats/min vs.(89.7±8.7)beats/min;both P<0.05].The dosage of propofol in the control group was greater than that in the study group[(269.2±29.2)mg vs.(216.7±25.2)mg;t=9.430,P<0.001].The recovery time in the control group was significantly longer than that in the study group[(6.9±1.3)min vs.(5.5±1.2)min;t=5.482,P<0.001].The incidences of locomotor response and respiratory depression in the control group were significantly higher than those in the study group[25.0%(12/48)vs.4.2%(2/48)and 31.2%(15/48)vs.6.2%(3/48);both P<0.05].There were no statistical differences in the incidences of postoperative nausea and vomiting and vertigo between the two groups(both P>0.05).Conclusion The use of dexmedetomidine,propofol,and a low dose of esmketamine in gynecological hysteroscopic anesthesia has smooth circulation and breathing,rapid postoperative recovery,good controllability,and a low incidence of adverse reactions,with high clinical application value.