艾司氯胺酮诱导睡眠对呼吸和气道梗阻的影响

Effect of Esketamine-induced Sleep on Respiratory and Airway Obstruction

目的:探讨艾司氯胺酮诱导睡眠对患者呼吸和气道梗阻的影响。方法:选择2021年1—6月于广东省人民医院珠海医院拟行药物诱导睡眠检查的患者60例,采用随机数法随机分为Ⅰ组、Ⅱ组,各30例。Ⅰ组使用艾司氯胺酮进行诱导睡眠,Ⅱ组使用咪达唑仑进行诱导睡眠,患者入睡后,在仰卧位下,使用纤维喉镜监测患者气道梗阻情况,记录用药前(T0)、用药后5 min(T1)、用药后10 min(T2)、用药后20 min(T3)、用药后30 min(T4)时的Ramsay镇静评分、呼吸频率(RR)、最低血氧饱和度(SpO2),睡眠呼吸监测指标、气道梗阻情况及不良反应等。结果:T1~T4时,两组Ramsay镇静评分比较,差异无统计学意义(P>0.05)。T1~T4时,两组SpO2均低于T0时,差异有统计学意义(P<0.05);T2~T4时,Ⅱ组SpO2低于Ⅰ组,差异有统计学意义(P<0.05)。T2~T4时,Ⅰ组RR均低于T0时,T1~T4时,Ⅱ组RR均低于T0时,差异有统计学意义(P<0.05);T1~T4时,Ⅱ组RR低于Ⅰ组,差异有统计学意义(P<0.05)。30 min药物诱导睡眠期间,Ⅰ组低通气指数(AHI)、呼吸暂停次数明显低于Ⅱ组,最低SpO_(2)、RR明显高于Ⅱ组,差异有统计学意义(P<0.05)。Ⅰ组中无狭窄患者占比高于Ⅱ组,且Ⅳ型狭窄患者占比低于Ⅱ组,差异有统计学意义(P<0.05)。两组各项不良反应发生率比较,差异无统计学意义(P>0.05)。结论:艾司氯胺酮诱导睡眠对呼吸抑制较轻,气道梗阻发生率较低。

Objective:To investigate the effects of Esketamine-induced sleep on respiratory and airway obstruction in patients.Method:A total of 60 patients who were to underwent drug-induced sleep examination in Guangdong Provincial People's Hospital Zhuhai Hospital from January to June 2021 were selected and randomly divided into groupⅠand groupⅡby random number method,with 30 patients in each group.GroupⅠwas given Esketamine to induce sleep,groupⅡwas given Midazolam to induce sleep.After falling asleep,the patients were monitored for airway obstruction in supine position with fibrolaryngoscope.Ramsay sedation score,respiratory rate(RR),minimum oxygen saturation(SpO2)before medication(T0),5 min after medication(T1),10 min after medication(T2),20 min after medication(T3)and 30 min after medication(T4),sleep-induced breathing monitoring indicators,airway obstruction and adverse reaction were recorded.Result:At T1-T4,there were no significant differences in Ramsay sedation score between the two groups(P>0.05).At T1-T4,SpO2 in both groups were lower than that at T0,and the differences were statistically significant(P<0.05).At T2-T4,SpO2 in groupⅡwas lower than that in groupⅠ,and the difference was statistically significant(P<0.05).At T2-T4,RR of groupⅠwas lower than that of T0,at T1-T4,RR of groupⅡwas lower than that of T0,and the differences were statistically significant(P<0.05).At T1-T4,RR in groupⅡwere lower than those in groupⅠ,and the differences were statistically significant(P<0.05).During 30 min of drug-induced sleep,apneahypopnea index(AHI)and number of apnea in groupⅠwere significantly lower than those in groupⅡ,and the minimum SpO2,RR was significantly higher than that in groupⅡ,the differences were statistically significant(P<0.05).The proportion of patients without stenosis in groupⅠwas higher than that in groupⅡ,and the proportion of patients with typeⅣstenosis was lower than that in groupⅡ,the differences were statistically significant(P<0.05).There were no significant differences in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Esketamine-induced sleep had lower incidence of respiratory depression and airway obstruction.