艾司氯胺酮在妇科与产科围手术期的应用进展

Application progress of esketamine in gynecology and obstetrics during perioperative period

妇科及产科手术量较大,围手术期循环波动、术后恶心呕吐及不良情绪体验等不良事件发生率较高,是临床医生需关注的问题。艾司氯胺酮是氯胺酮的右旋异构体,对N-甲基-D-天冬氨酸受体具有较强亲和力,是一种快速起效的麻醉镇痛药物,同时具有快速抗抑郁作用,可通过多种途径给药,在临床麻醉、术后镇痛及抑郁症治疗方面都得到了广泛应用。艾司氯胺酮注射剂应用于临床实践时间尚短,其在围手术期应用获益及机制尚未完全阐明,是近年来的研究热点。目前国内外的许多研究报道艾司氯胺酮注射剂应用于妇产科手术能够起到稳定循环、减轻呼吸抑制、恶心呕吐等不良反应的作用,且在一定条件下对产后抑郁的防治也有益处,但也存在一过性的拟精神症状等不良反应。本文结合妇科与产科手术的围手术期特点,从艾司氯胺酮的药理作用、围手术期应用以及对术后恢复的影响进行综述,阐明其目前的应用现状,及未来可能的临床应用及研究方向,为广大临床工作者提供参考。

The volume of gynecological and obstetric surgeries is large,and the high rates of adverse events incidence such as perioperative cycle fluctuations,postoperative nausea and vomiting and adverse emotional experiences,which is a concern for clinicians.Esketamine is a right-handed isomer of ketamine with a strong affinity for the N-methyl-Daspartate receptor(NMDAR),which has a rapid anesthetic,analgesic and antidepressant effect.It can be administered through multiple routes and has been widely used in clinical anesthesia,postoperative analgesia and depression treatment.The application of esketamine injection in clinical practice is still relatively short,and the benefits and mechanisms during perioperative application have not been fully elucidated,making it a research hotspot in recent years.Many studies have reported that the application of esketamine injection in obstetrics and gynecology surgery can stabilize circulation,and reduce respiratory depression,nausea and vomiting and other adverse reactions.It is also beneficial for the prevention and treatment of postpartum depression under certain conditions,but sometimes there are also temporary pseudo-psychiatric symptoms and other adverse reactions.In this article,we review the pharmacological effects,perioperative application and impact on postoperative recovery of esketamine based on the specialty characteristics of obstetrics and gynecology surgery,and clarify its current application status,as well as possible clinical applications and research directions in the future,to provide reference for the clinicians.