不同剂量艾司氯胺酮复合丙泊酚在无痛胃镜检查中的效果比较

Effect of different doses of esketamine mixed with propofol for Painless gastroscopy

目的:比较不同剂量艾司氯胺酮分别复合丙泊酚用于无痛胃镜的麻醉效果、安全性和不良反应。方法:选取拟行无痛胃镜检查的患者200例,按照麻醉方案不同分为E_(1)、E_(2)、E_(3)和C组,其中C组为对照组(n=51),不使用艾司氯胺酮,E_(1)组(n=49)、E_(2)组(n=51)和E_(3)组(n=49)为试验组。C组静脉缓推生理盐水,E_(1)、E_(2)和E_(3)组分别静脉推注艾司氯胺酮0.125、0.25和0.5 mg/kg。1 min后所有患者静脉缓推丙泊酚1.5~3 mg/kg。观察各组不同时间点[麻醉诱导前(T_(0))、麻醉诱导后(T_(1))、胃镜置入时(T_(2))、撤出胃镜时(T_(3))和苏醒时(T_(4))]平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO_(2))、丙泊酚用量、诱导时间、胃镜检查时间和苏醒时间、检查中体动及呛咳的发生情况,以及患者诱导前和苏醒后简易精神状态检查量表(MMSE)评分和各种不良反应发生情况。结果:T_(1-4)时,C组MAP低于实验组(P<0.05);在T_(3)时,E_(3)组SpO_(2)低于E_(1)和E_(2)组(P<0.05);与C组相比,实验组丙泊酚用量降低(P<0.05);与C组和E_(1)组相比,E_(2)和E_(3)组诱导时间缩短(P<0.05);与E_(1)组和E_(2)组相比,E_(3)组苏醒时间延长,术后MMSE评分降低(P<0.05);与C组和E_(1)组相比,E_(2)组体动发生率降低(P<0.05),E_(2)组和E_(3)组头晕发生率增加(P<0.05);实验组丙泊酚注射痛较C组降低(P<0.05);与其他3组相比,E_(3)组恶心呕吐和精神症状发生率增加(P<0.05)。结论:实施无痛胃镜检查的患者,使用艾司氯胺酮0.25 mg/kg复合丙泊酚更为安全有效。

Objective:To compare the anesthetic effects,safety and side effects of different doses of esketamine combined with propofol in painless gastroscopy.Methods:200 patients undergoing painless gastroscopy were divided into a control group(group C,n=51)without intravenous esketamine,and three experimental groups[groups E_(1)(n=49),E_(2)(n=51)and E_(3)(n=49)]according to different anesthesia protocols.The patients in group C was given intravenous saline,and the patients in groups E_(1),E_(2) and E_(3) were intravenous injected esketamine with 0.125,0.25 and 0.5 mg/kg,respectively.All the four groups were given propofol 1.5-3mg/kg until patient s eyelash reflex disappeared.The mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO_(2)),consumed dosages of propofol,the induction time,gastroscopy time and awakening time,the occurrence of body movement and cough,Mini-mental state examination(MMSE)score before and after anesthesia,and the incidence of adverse reactions at different time points in each group were observed before anesthesia(T_(0)),after anesthesia(T_(1)),when placing gastroscopy(T_(2)),when taking out of gastroscopy(T_(3))and when senses recovery(T_(4)).Results:Compared with group C,MAP in experimental groups were higher at T_(1-4)(P<0.05).Compared with group E_(1) and E_(2),SpO_(2) in group E_(3) were lower at T_(3)(P<0.05).Compared with group C,the consumed doses of propofol in groups E_(1),E_(2) and E_(3) were lower(P<0.05).Compared with group C and E_(1),the induction time in group E_(2) and E_(3) were lower(P<0.05).Awakening time in group E_(3) were longer and the MMSE scores were less than that in group E_(1) and E_(2)(P<0.05).The incidence of body movement in group E_(2) were less than that in group C and group E_(1)(P<0.05).The dizziness rate either in group E_(2) and group E_(3) was higher than that in group C and group E_(1)(P<0.05).The incidence of propofol injection pain in any experimental groups was lower than that in group C(P<0.05).Nausea and vomiting and psychiatric symptoms in group E_(3) were more than that in other groups(P<0.05).Conclusion:Esketamine 0.25mg/kg combined with propofol was safe and effective in patients with gastroscopy.