小剂量氯胺酮复合地塞米松、舒芬太尼、异丙酚用于男性吸烟患者无痛胃镜检查的临床观察

Clinical observation of low-dose ketamine combined with dexamethasone,sufentanil and propofolon painless gastroscopy in male smoking patients

[目的]探讨小剂量氯胺酮复合地塞米松、舒芬太尼、异丙酚用于男性吸烟患者无痛胃镜检查的临床效果及安全性。[方法]170例接受无痛胃镜检查的男性吸烟患者随机分为氯胺酮组与对照组,每组85例。对照组静脉推注地塞米松5mg、舒芬太尼0.1μg/kg,2min后静脉推注异丙酚1.5~2.5mg/kg;氯胺酮组静脉推注地塞米松5 mg、舒芬太尼0.1μg/kg、氯胺酮0.1mg/kg,2min后静脉推注异丙酚1.5~2.5mg/kg。比较2组诱导时间、检查时间、苏醒时间、定向力恢复时间、异丙酚用量、追加次数、麻醉效果、患者舒适度、不良事件及检查前、后C反应蛋白(CRP)及皮质醇(Cor)、去甲肾上腺素(NE)水平。观察入室即刻(T0)、药物静注完毕(T1)、胃镜通过会厌(T2)、麻醉后3min(T3)、检查结束(T4)时平均动脉压、心率、血氧饱和度。[结果]氯胺酮组与对照组诱导时间、检查时间、苏醒时间、定向力恢复时间比较差异无统计学意义(P>0.05),氯胺酮组异丙酚用量低于对照组(P<0.05)。2组T1时心率、平均动脉压、血氧饱和度降低,T3时有所上升,而对照组T2、T3时降低更明显(P<0.05)。与检查前比较,2组检查后CRP、Cor、NE水平增高,但氯胺酮组增高幅度低于对照组(P<0.05)。氯胺酮组麻醉效果及患者舒适度优于对照组(P<0.05)。⑤氯胺酮组体动、呛咳、呼吸抑制、低血压等不良反应的发生率均低于对照组(P<0.05)。[结论]小剂量氯胺酮复合地塞米松、舒芬太尼、异丙酚可安全有效地用于男性吸烟患者无痛胃镜检查过程。

[Objective]To explore the safety and effectiveness of low-dose ketamine combined with dexamethasone,sufentanil and propofol on painless gastroscopy in male smoking patients.[Methods]One hundred and seventy male smokers who underwent painless gastroscopy were randomly divided into control group and ketamine group,with eighty-five cases in each group.Dexamethasone 5mg,sufentanil 0.1g/kg,propofol 1.5-2.5mg/kg were injected intravenously in the control group,the ketamine group increased ketamine to 0.1mg/kg on the basis of control group.Induction time,examination time,waking time,directional force recovery time,propofol dosage,times of supplementation,anesthetic effect,patient comfort,adverse events and C-reactive protein(CRP),cortisol(Cor)and norepinephrine(NE)levels before and after examination were compared between the two groups.MAP,HR,SpO2were observed at the time of entering the gastroscopic chamber(T0),at the end of intravenous infusion(T1),gastroscope through epiglottis(T2),3min after anesthesia(T3)and at the end of examination(T4).[Results]There was no significant difference in induction time,examination time,waking time and recovery time of directional force between the two groups(P>0.05),and propofol dosage in the ketamine group was lower than that in the control group(P<0.05).HR,MAP and SpO2decreased in the two groups at T1,increased at T3,and decreased significantly in the control group at T2and T3(P<0.05).Compared with that before the examination,the levels of CRP,Cor and NE increased after the examination in the two groups,but the increase in the ketamine group was lower than that in the control group(P<0.05).The anesthetic effect and comfort of patients in the ketamine group were better than those in the control group(P<0.05).The incidence of body movement,cough,respiratory depression,hypotension in the ketamine group was lower than that in the control group(P<0.05).[Conclusion]Low-dose ketamine combined with dexamethasone,sufentanil and propofol can be safely and effectively used in painless gastroscopy in male smokers.