小剂量艾司氯胺酮复合丙泊酚用于成人无痛胃肠镜检查的有效性和安全性

The efficacy and safety of low dose esketamine combined with propofol for painless gastroenteroscopy in adults

目的探讨在成人无痛胃肠镜检查中小剂量艾司氯胺酮复合丙泊酚的有效性和安全性。方法收集2021年9—12月本院行无痛胃肠镜检查的患者180例,采用随机号码表法将患者分为艾司氯胺酮复合丙泊酚麻醉组(E组)与丙泊酚单纯麻醉(P组),每组各90例。E组静脉注射艾司氯胺酮0.20 mg/kg,30 s后给予丙泊酚1.5~2.5 mg/kg;P组静脉注射与E组所用艾司氯胺酮同等容量的生理盐水,30 s后给予丙泊酚1.5~2.5 mg/kg,两组根据胃肠检查情况术中丙泊酚继续诱导。记录患者一般情况,丙泊酚的用量以及苏醒时间。记录患者入室时(T_(0))、诱导时(T_(1))、内镜经过咽喉部(T_(2))和乙状结肠部(T_(3))、出室时(T_(4))的MAP、HR、SPO_(2)。记录诱导结束(T_(1))时的BIS评分。记录不良事件发生率以及相应的处理方法。记录术后梦境的发生情况。结果E组丙泊酚累积用量显著低于P组(P<0.05),而E组苏醒时间与P组差异无统计学意义。与T_(0)时比较,T_(1)~T_(4)时P组MAP明显下降(P<0.05),T_(2)~T_(4)时P组心率明显下降(P<0.05),而E组在T_(3)、T_(4)时MAP、心率明显下降(P<0.05);T_(1)、T_(2)、T_(4)时,E组MAP下降变化明显小于P组(P<0.05)。术中低血压、脉氧饱和度降低、呃逆的发生率E组也明显低于P组(P<0.05)。术后正性梦境的发生率E组明显高于P组(P<0.05)。结论小剂量艾司氯胺酮复合丙泊酚可以安全应用于无痛胃肠镜检查,比单纯使用丙泊酚更具有对循环、呼吸影响小、改善梦境等临床优势。

Objective To investigate the efficacy and safety of small dose esketamine combined with propofol in adult painless gastroenteroscopy.Methods A total of 180 patients who underwent painless gastroenteroscopy in our hospital from September to December 2021 were collected.Patients were divided into esketamine combined with propofol anesthesia group(group E)and propofol anesthesia alone group(group P)by random number table method,with 90 cases in each group.Intravenous escitalopram ketamine group E 0.20 mg/kg,after the 30 s to give propofol 1.5~2.5 mg/kg.P group escitalopram ketamine used the same capacity of physiological saline,30 s to give propofol after 1.5~2.5 mg/kg.Propofol induction was continued in both groups according to gastrointestinal examination.The patient's general condition,propofol dosage and recovery time were recorded.MAP,HR,and SPO were recorded at entry(T-vertex 0),induction(T-vertex 1),endoscopic passage through throat(T-vertex 2)and sigmoid colon(T-vertex 3),and exit(T-vertex 4).BIS scores were recorded at the end of induction(T-1).The incidence of adverse events,the corresponding treatment methods and the occurrence of postoperative dreams were recorded.Results The cumulative dosage of propofol in group E was obviously lower than that in group P(P<0.05),and there was no statistical significance between group E and group P in the time of awakening.Comparison with T_(0),MAP of group P was dramatically declined from T_(1) to T_(4)(P<0.05),and HR of group P was sharply decreased from T_(2) to T_(4)(P<0.05),while MAP and HR of group E were significantly decreased during T_(3) and T_(4)(P<0.05).At T_(1),T_(2) and T_(4),the decrease of MAP in group E was significantly smaller than that of group P(P<0.05).The incidence of intraoperative hypotension,decreased pulse oxygen saturation and hiccups in P group was significantly higher than that in group E(P<0.05).The incidence of postoperative positive dreams in group E was significantly higher than that in group P(P<0.05).Conclusion Low-dose of esketamine combined with propofol can be safely used on painless gastroenteroscopy,which has more clinical advantages than pure propofol in terms of less impact on circulation,respiration and improving dreams.