小剂量氯胺酮联合丙泊酚和瑞芬太尼麻醉诱导在食管静脉曲张患者内镜下硬化剂治疗中的应用

Application of anesthesia induction with low-dose ketamine combined with propofol and remifentanil in endoscopic sclerotherapy for patients with esophageal varices

目的评估小剂量氯胺酮联合丙泊酚和瑞芬太尼麻醉诱导在食管静脉曲张患者内镜下硬化剂治疗中的安全性和有效性。方法行内镜下硬化剂治疗的食管静脉曲张患者60例随机分为两组,每组30例。麻醉诱导:P组应用瑞芬太尼0.3μg/kg和丙泊酚2mg/kg;K组应用瑞芬太尼0.3μg/kg、丙泊酚1mg/kg和氯胺酮0.3mg/kg。两组麻醉维持均使用丙泊酚4mg·kg^(-1)·h^(-1)静脉泵注。记录麻醉诱导前(T0)、诱导后(T1)、进镜时(T2)和进镜后5min(T3)的HR和MAP;记录呼吸抑制、低血压、严重心动过缓以及体动反应发生情况。结果与T0时相比,P组T1~T3时MAP和HR均下降,K组T1~T3时MAP下降,T3时HR下降(P<0.01)。K组T1~T3时MAP和HR均高于P组(P<0.01)。K组呼吸抑制发生率低于P组(P<0.05),两组低血压和体动反应发生率比较无统计学差异(P>0.05),两组均未出现严重心动过缓。结论内镜下硬化剂治疗食管静脉曲张患者的麻醉诱导应用氯胺酮0.3mg/kg联合丙泊酚和瑞芬太尼对循环抑制小,且能降低呼吸抑制发生率。

Objective To evaluate the safety and efficacy of anesthesia induction with low-dose ketamine combined with propofol and remifentanil in endoscopic sclerotherapy for patients with esophageal varices.Methods Sixty patients with esophageal varices undergoing endoscopic sclerotherapy were randomized into two groups,with 30cases each.Anesthesia was induced with remifentanil 0.3μg/kg and propofol 2 mg/kg in group P,which was induced with remifentanil 0.3μg/kg,propofol 1mg/kg and ketamine 0.3mg/kg in group K.Anesthesia was maintained with propofol 4mg·kg^(-1)·h^(-1)in two groups.The HR and MAP before induction(T0),after induction(T1),immediately after entering the endoscope(T2),and 5minutes after entering the endoscope(T3)were recorded.The occurrence of respiratory depression,hypotension,severe bradycardia and body movement was recorded.Results Compared with T0,MAP and HR were decreased at T1to T3 in group P,MAP was decreased at T1to T3and HR was decreased at T3in group K(P<0.01).The MAP and HR of group K were higher than those of group P at T1to T3(P<0.01).The incidence of respiratory depression in group K was lower than that in group P(P<0.05).There was no significant difference in the incidence of hypotension and body movement between the two groups(P>0.05).No severe bradycardia events occurred in the two groups.Conclusion In the patients with esophageal varices undergoing endoscopic sclerotherapy,anesthesia induction with ketamine 0.3mg/kg combined with propofol and remifentanil has less circulatory and respiratory suppression.