艾司氯胺酮联合丙泊酚静脉麻醉对宫腔镜手术患者术中体征及苏醒质量影响

Impacts of the intravenous anesthesia by esketamine combined with propofol during hysteroscopic surgery of patients on their intraoperative physical signs and recovery quality

目的:探讨宫腔镜手术艾司氯胺酮联合丙泊酚方案静脉麻醉对患者术中体征及苏醒质量的影响。方法:选取本院2022年3-10月拟行宫腔镜手术的患者80例,随机分为观察组和对照组各40例,分布使用艾司氯胺酮联合丙泊酚或舒芬太尼联合丙泊酚方案静脉麻醉。比较两组术前术后疼痛评分、术中体征[动脉血氧饱和度(SpO_(2))、呼吸频率(RR)、心率(HR)及平均动脉压(MAP)]、麻醉起效时间、术后唤醒时间、患者满意度、苏醒质量及术后不良反应情况。结果:观察组麻醉起效时间(32.0±5.3s)、术后唤醒时间(2.6±0.9min)短于对照组(41.7±8.3s、4.2±1.0min),丙泊酚用量(1.9±0.3 mg/kg)少于对照组(2.4±0.4 mg/kg),术后10 min、30 min VAS评分(3.83±0.68分、3.27±0.59分)低于对照组(4.72±0.67分、4.26±0.66分)(均P<0.05),两组术后24 h VAS评分(1.46±0.22分)及术后满意度(92.5%)与对照组(1.49±0.25分、82.5%)无差异(P>0.05)。麻醉前两组SpO_(2)、RR、HR、MAP体征指标比较无差异(P>0.05),在睫毛反应消失~意识恢复时,对照组SpO_(2)、RR低于麻醉前但观察组优于对照组,扩张宫颈时~手术开始5 min时,两组HR高于麻醉前,手术开始5 min时~意识恢复时,两组MAP高于麻醉前(P<0.05);入监测治疗室(PACU)5 min时、出PACU时观察组Steward苏醒评分(3.61±0.70分、5.58±0.46分)均高于对照组(3.26±0.62分、5.12±0.53分),出PACU时观察组苏醒期Ricker镇静-躁动评分(5.36±0.65分)低于对照组(5.83±0.71分)(P<0.05),不良反应总发生观察组(5.0%)与对照组(20.0%)无差异(P>0.05)。结论:宫腔镜手术艾司氯胺酮联合丙泊酚静脉麻醉,镇静镇痛作用提高,未增加不良反应。

Objective:To investigate the impacts of the intravenous general anesthesia by esketamine combined with propofol during hysteroscopic surgery of patients on their intraoperative physical signs and recovery quality.Methods:80 patients who were scheduled to undergo hysteroscopic surgery were selected as rescarch subjects and randomly di-vided into two groups(40 cases in each group)from March to October 2022.The patients in the study group had re-ceived intravenous general anesthesia by esketarmine combined with propofol regimen,while the patients in the control group had received intravenous general anesthesia by sufentanil combined with propofol.The preoperative and postop-erative pain scores,the values of intraoperative physical signs,such as arterial oxygen saturation(SpO_(2)),respiratory rate(RR),heart rate(HR),and mean arterial pressure(MAP),the onset time of anesthesia,the postoperative a-wakening time,the satisfaction,the recovery quality,and the postoperative adverse reactions rate of the patients were compared between the two groups.Results:The anesthetic onset time(32.0±5.3s)and the postopecrative awakening time(2.6±0.9min)of the patients in the study group were significantly shorter than those(41.7±8.3s and 4.2±1.0 min)of the patients in the control group,and the dosage of propofol used(1.9±0.3 mg/kg)of the patients in the study group was significantly less than that(2.4±0.4 mg/kg)of the patients in the control group.The VAS scores at 10 min(3.83±0.68 points)and in 30 min after operation(3.27±0.59 points)of the patients in the study group were significantly lower than those(4.72±0.67 points and 4.26±0.66 points)of the patients in the control group(P<0.05).The VAS score in postoperative 24 h(1.46±0.22 points)and the postoperative satisfaction rate(92.5%)of the patients in the study group had no significantly different from those(1.49±0.25 points and 82.59%)of the patients in the control group(P>0.05).There were no significant dffences in the values of SpOz.RR,HR,and MAP of the patients before anesthesia between the two groups(P>0.05).From the absence of eyelash response to the recovery of consciousness,the SpO_(2) and RR walues of the patients in the control group were significantly lower than those before anesthesia,but which of the patients in the study group were significantly better than those of the patients in the con-rol group.The HR value of the patients in both groups from the cervical dilation to 5 min after the start of surgery was significantly higher than that before anesthesia,and the MAP value of the patients in both groups from 5 min after the start of surgery to the consciousness recovery was significantly higher than that before anesthesia(P<0.05).The Steward recovery scores at 5 min after entering the postanesthesia care unit(PACU)(3.61±0.70 points)and after leaving PACU(5.58±0.46 points)of the patients in the study group were significantly higher than those(3.26±0.62 points and 5.12±0.53 points)of the patients in the control group.The Ricker sedation-agitation score(5.36±0.65 points)of the patients in the study group was significantly lower than that(5.83±0.71 points)of the patients in the control group(P<0.05).There was no significant dfference in the total adverse reactions rate(5.0%vs.20.0%)of the patients between the two groups(P>0.05).Conclusion:Esketamine combined with propofol for intravenous gen-eral anesthesia during hysteroscopic surgery of the patients can increase the analgesic ffect,and without increase of the adverse reactions.