艾司氯胺酮及舒芬太尼分别复合丙泊酚在无痛胃镜检查中的应用比较

Comparison of the application of Esketamine and sufentanil combined with propofol in painless gastroscopy

目的 观察艾司氯胺酮及舒芬太尼分别复合丙泊酚在无痛胃镜检查中的麻醉效果及安全性。方法 以安徽省固镇县人民医院麻醉科2021年12月~2022年8月收治的128例无痛胃镜检查患者作为本次随机双盲研究对象。按照不同静脉麻醉方法将其分为对照组(n=64例,舒芬太尼复合丙泊酚)和观察组(n=64例,艾司氯胺酮复合丙泊酚),比较两组患者麻醉过程中血流动力学指标、苏醒时间、清醒时间、丙泊酚用量、苏醒后改良Aldrete评分达10分时的MMSE评分(简易精神状态检查量表)及体动、呛咳、呼吸抑制、恶心呕吐等不良反应总发生率。结果 (1)两组患者在麻醉诱导前(T_(0))时平均动脉压(MAP)、心率(HR)及脉搏氧饱和度(SpO_(2))比较,差异无统计学意义(P>0.05);麻醉诱导后(T_(1))、插入胃镜时(T_(2))、胃镜检查3min后(T_(3))三个不同时间点两组患者MAP、HR、SpO_(2)均呈下降趋势,但组间比较差异明显(P<0.05);胃镜拔出后(T_(4))两组患者SpO_(2)均较T_(3)上升,并且组间比较差异仍显著(P<0.05);(2)观察组较对照组患者苏醒时间、清醒时间短,丙泊酚用量少,组间比较,差异有统计学意义(P<0.05);(3)两组患者苏醒后MMSE评分比较,观察组虽略高于对照组,但无统计学差异(P>0.05);(4)观察组在胃镜检查过程中体动、呛咳、呼吸抑制、恶心呕吐等不良反应总发生率为28.13%,远低于对照组的48.44%,组间比较差异明显(P<0.05)。结论 无痛胃镜检查麻醉方案的选择上,艾司氯胺酮复合丙泊酚在麻醉效果及安全性方面总体优于舒芬太尼复合丙泊酚,临床推广价值较高。

Objective To observe the anesthetic effect and safety of Esketamine and sufentanil combined with propofol in painless gastroscopy.Methods One hundred and twenty-eight patients with painless gastroscopy admitted to the Anesthesia Department of Guzhen County People's Hospital of Anhui Province from January 2021 to August 2022 were selected as the subjects of this randomized double-blind study.According to different methods of intravenous anesthesia,the patients were allocated into control group(n=64 cases,sufentanil combined with propofol) and observation group(n=64 cases,Esketamine combined with propofol).The hemodynamic indexes,awakening time,awakening time,dosage of propofol,MMSE score(simplified mental state examination scale),body movement,choking,respiratory depression and total incidence of adverse reactions such as nausea and vomiting.Results(1)Mean arterial pressure(MAP) and heart rate(HR) of the two groups before anesthesia induction(T_(0)) and pulse oxygen saturation(SpO_(2)) had no significant difference(P>0.05);MAP,HR and SpO_(2) of patients in the two groups showed a downward trend at three different time points,after anesthesia induction(T_(1)),insertion of gastroscope(T_(2)) and 3 min after gastroscopy(T_(3)),but there was significant difference between the two groups(P<0.05);SpO_(2) of patients after gastroscope extraction(T_(4)) in both groups was higher than that in T_(3),and the difference between the two groups was still significant(P<0.05);(2)Compared with the control group,the patients in the observation group had shorter awakening time,shorter waking time,and less dosage of propofol.The difference between the two groups was statistically significant(P<0.05);(3)Compared with the MMSE scores of the two groups after awakening,the observation group was slightly higher than the control group,but there was no statistical difference(P>0.05);(4)The total incidence of adverse reactions such as body movement,cough,respiratory depression,nausea and vomiting during gastroscopy in the observation group was 28.13%,far lower than 48.44% in the control group,with significant difference between the groups(P<0.05).Conclusion In the selection of anesthesia scheme for painless gastroscopy,Esketamine combined with propofol is generally superior to sufentanil combined with propofol in terms of anesthesia effect and safety,and has high clinical popularization value.