丙泊酚复合低剂量艾司氯胺酮应用于无痛超声支气管镜检查的效果

Effect of propofol combined with low-dose esketamine on painless endobroncheal ultrasonography

目的:评估丙泊酚复合低剂量艾司氯胺酮应用于无痛超声支气管镜(EBUS)检查的效果。方法:纳入2022年4月至8月在郑州大学第一附属医院行无痛EBUS检查的96例患者(年龄18~65岁,BMI 18.5~28.0 kg/m^(2),ASAⅡ或Ⅲ级),随机分为艾司氯胺酮组和对照组,每组48例。对照组麻醉诱导方案为丙泊酚1.5 mg/kg+阿芬太尼30μg/kg+米库氯铵0.15 mg/kg,艾司氯胺酮组在此基础上加用艾司氯胺酮0.25 mg/kg;术中根据患者反应持续泵注瑞芬太尼0.25~4.00μg/(kg·min)和丙泊酚4~6 mg/(kg·h)。记录苏醒期呛咳程度和发生率,记录麻醉前、麻醉诱导后、超声支气管镜进入声门时、穿刺时和苏醒即刻的平均动脉压和心率,记录检查时间、苏醒时间、拔管时间及不良反应发生情况。结果:艾司氯胺酮组苏醒期呛咳程度及发生率均低于对照组(P<0.05);艾司氯胺酮组平均动脉压和心率波动幅度均小于对照组(P<0.05);艾司氯胺酮组低血压、心动过缓发生率低于对照组(P<0.05);两组检查时间、苏醒时间、拔管时间及不良反应发生率(包括心动过速、头晕、躁动、视力模糊)比较,差异均无统计学意义(P>0.05)。结论:丙泊酚复合低剂量艾司氯胺酮能降低无痛EBUS检查苏醒期呛咳的发生,且血流动力学更稳定。

Aim:To observe the effect of propofol combined with low-dose esketamine on painless endobroncheal ultrasonography(EBUS).Methods:A total of 96 patients(aged 18-65 years,with BMI 18.5-28.0 kg/m 2,ASAⅡorⅢ)for painless EBUS at the First Affiliated Hospital of Zhengzhou University from April to August 2022 were selected,and allocated into 2 groups randomly,esketamine group and control group,with 48 patients in each group.During anesthesia induction,control group was given propofol 1.5 mg/kg and alfentanil 30μg/kg,followed by mivacurium 0.15 mg/kg intravenously,while esketamine group received esketamine 0.25 mg/kg in addition to control group.During procedure,both groups received continuous intravenous remifentanil 0.25-4.00μg/(kg·min)and propofol 4-6 mg/(kg·hour)based on response of patients.The incidence and degree of cough during recovery period were recorded.Heart rate and mean arterial pressure(MAP)were recorded prior to induction(T 1),after anesthesia induction(T 2),at ultrasound bronchoscopy through the glottis(T 3),at puncture(T 4)and after awakening(T 5).The examination time,awakening time,extubation time and adverse reactions were also recorded.Results:Compared with control group,the incidence and degree of cough in the esketamine group were lower(P<0.05).The ranges of change of MAP and heart rate in the esketamine group were less than those of control group(P<0.05);the incidence of hypotension and bradycardia in the esketamine group decreased(P<0.05).There were no significant differences in examination time,awakening time,extubation time or the rate of adverse reaction(tachycardia,dizziness,restlessness and blurred vision)between the 2 groups(P>0.05).Conclusion:Propofol combined with low-dose esketamine used in painless EBUS can reduce the incidence and degree of cough during anesthesia recovery,and better maintain hemodynamic stability.