艾司氯胺酮复合丙泊酚应用于肥胖患者宫腔镜检查术的效果

Application of esketamine combined with propofol in Hysteroscopy of obese patients

目的观察艾司氯胺酮复合丙泊酚麻醉在肥胖患者宫腔镜检查术的应用效果。方法选择2022年1月-6月择期行无痛宫腔镜检查的肥胖患者60例,BMI 30 kg/m^(2)-40 kg/m^(2),随机分为两组(n=30),E组为艾司氯胺酮-丙泊酚组,接受艾司氯胺酮0.25 mg/kg复合丙泊酚1.0 mg/kg麻醉;S组为舒芬太尼-丙泊酚组,接受舒芬太尼0.1μg/kg复合丙泊酚1.0 mg/kg麻醉。记录检查中麻醉效果、术后镇痛效果及术中不良反应发生情况。结果与麻醉开始比较,进镜时、苏醒时两组患者HR、SBP、DBP明显降低(P<0.05)。与S组相比较,E组苏醒时间、复苏时间明显缩短(P<0.05),丙泊酚追加率和丙泊酚追加总量明显减少(P<0.05),苏醒后25 min宫缩痛程度明显降低(P<0.05)。与S组比较,E组托下颌、体动、心动过缓、恶心、呕吐发生率明显降低(P<0.05)。讨论艾司氯胺酮复合丙泊酚麻醉提高了肥胖患者宫腔镜检查术中舒适度,缩短了检查后麻醉恢复时间。

Objective To observe the anesthetic effect of esketamine combined with propofol in hysteroscopy of obese patients.Methods A total of Sixty patients,aged 20-60 years old,with BMI 30 kg/m-40 kg/m^(2),ASA grade Ⅱ or Ⅲ,who underwent elective painless hysteroscopy from January to June 2022 were randomized into 2 groups,Esketamine-Propofol group(group E)and Sufentanilpropofol group(group S),with 30 patients in each group.Group E were slowly given esketamine 0.25 mg/kg followed by propofol 1.0 mg/kg intravenously,while group S was slowly injected with sufentanil 0.1μg/kg followed by slow intravenous propofol 1.0 mg/kg.HR,SBP,DBP and SpO_(2) were recorded immediately after anesthesia,during operation and after recovery.The onset time of anaesthesia,the number of additional cases of propofol,the time of recovery,the residence time of resuscitation room,and the digital analog score(NRS)of uterine pain at 5,15,25 min after recovery were recorded.Moreover,the adverse reactions such as propofol injection pain,jaw support,body movement,dizziness,nausea,vomiting and coughing were recorded.Results Compared with the beginning of anesthesia immediately,HR,SBP and DBP were significantly decreased between the two groups immediately after admission and immediately after recovery(P<0.05),while SpO_(2) had no statistical difference(P>0.05).There was no significant difference in the changes of vital signs between two groups at different times(P>0.05).Compared with group S,the recovery time and dwell time of resuscitation room in group E were significantly shortened(P<0.05),the supplemental rate and total amount of propofol were significantly reduced(P<0.05),and the degree of uterine contraction pain was significantly decreased 25 minutes after recovery(P<0.05).There was no statistical significance in the onset time of anesthesia between two groups(P>0.05).Compared with group S,the incidence of jaw support,body movement,bradycardia,nausea and vomiting in group E was significantly decreased(P<0.05),and there was no statistical significance in pain,dizziness and cough after propofol injection between the two groups(P>0.05).Conclusion Esketamine combined with propofol can improve the anesthesia and postoperative analgesic,accelarate postoperative recovery,strengthen the postoperative anesthesia,and adverse reactions are mild.