低剂量艾司氯胺酮复合丙泊酚在无痛肠镜检查中的应用

Application of Low-Dose Esketamine Combined with Propofol Sedation in Painless Colonoscopy

目的探讨低剂量艾司氯胺酮复合丙泊酚镇静在无痛肠镜检查中的应用。方法选取拟行无痛肠镜检查的患者60例,随机分为:低剂量艾司氯胺酮组(S组)和对照组(C组)。两组均使用靶控输注(target control infusion,TCI)模式泵入丙泊酚,初始血浆靶控浓度3.0μg·mL^(-1),患者意识消失后,S组静脉注射艾司氯胺酮0.15 mg·kg^(-1),C组患者注射等量生理盐水。比较两组患者丙泊酚用量、内镜医师满意度、肠镜时间,苏醒时间、复苏室停留时间、患者满意度、记录与镇静相关不良事件发生情况。结果与C组比较,S组丙泊酚用量减少,使用血管活性药物比例、低血压和心动过缓发生率降低(P<0.05)。两组患者内镜医师操作满意度、肠镜时间、苏醒时间、复苏室停留时间,血氧饱和度降低、严重血氧饱和度降低、需要气道干预、恶心、呕吐的发生率比较差异无统计学意义(P>0.05)。两组患者第一次使用血管活性药物和第一次需要气道干预的时间比较差异无统计学意义(P>0.05)。结论低剂量艾司氯胺酮复合丙泊酚镇静可减少肠镜检查中丙泊酚用量,降低血管活性药物使用比例,减少低血压和心动过缓不良反应的发生率,值得临床推广应用。

OBJECTIVE To explore the application of low-dose esketamine combined with propofol sedation in painless colonoscopy.METHODS Sixty patients scheduled for painless colonoscopy were randomly divided into the low-dose esketamine group(S group)and control group(Group C).Both groups were treated with intravenous infusion of propofol in TCI mode,and the initial target plasma concentration was 3.0μg·mL^(-1).After the patient's consciousness disappeared,group S was intravenously injected with esketamine 0.15 mg·kg^(-1),and group C was intravenously injected with the same volume of normal saline.Total propofol consumption,endoscopist satisfaction with operation,operation time,recovery time,duration of post-anesthesia recovery room,patient satisfaction,sedation-related adverse events in two groups were recorded and compared.RESULTS Compared with the group C,the requirement of propofol in group S was significantly decreased,the proportion of vasoactive drugs required during operation,the incidence of hypotension and of bradycardia were significantly decreased(P<0.05).There was no significant difference in endoscopist satisfaction with operation,operation time,postoperative recovery time,residence time in the resuscitation room,the incidence of blood oxygen saturation reduction,severe blood oxygen saturation reduction,need for airway intervention,nausea and vomiting between the two groups(P>0.05).The first time use of vasoactive drugs and the first time need for airway intervention were not statistically significant between the two groups(P>0.05).CONCLUSION Low-dose esketamine combined with propofol sedation can reduces the dosage of propofol,the use of vasoactive drugs and the incidence of hypotension and bradycardia during painless colonoscopy,which is worth clinical promotion and application.