不同剂量艾司氯胺酮复合环泊酚用于无痛胃肠镜检查的麻醉效果

Effects of different doses of esketamine combined with ciprofol in patients undergoing painless gastrointestinal endoscopy

目的探讨不同剂量艾司氯胺酮复合环泊酚用于无痛胃肠镜检查的有效性和安全性。方法择期行门诊无痛胃肠镜检查的患者240例,年龄18~64岁,体重指数(BMI)18~30 kg/m^(2),美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级,按随机数字表法分为4组(每组60例):艾司氯胺酮0.2 mg/kg组(E1组)、艾司氯胺酮0.3 mg/kg组(E2组)、艾司氯胺酮0.4 mg/kg组(E3组)、单纯环泊酚麻醉组(C组)。E1组、E2组、E3组分别静脉注射艾司氯胺酮0.2、0.3、0.4 mg/kg,30 s后静脉注射环泊酚0.2~0.4 mg/kg;C组静脉注射环泊酚0.4 mg/kg。记录4组患者改良警觉/镇静评分(mOAA/S)≤1分时间、检查时间、苏醒时间、离院时间。记录4组患者入室时(T_(0))、进胃镜后即刻(T_(1))、出胃镜时(T_(2))、进肠镜后即刻(T_(3))、内镜到达回盲部时(T_(4))、肠镜结束时(T_(5))及清醒时(T_(6))的心率、脉搏血氧饱和度(SpO_(2))、平均动脉压(MAP)、呼吸频率(RR)、脑电双频指数(BIS),记录4组患者术中(呛咳、呼吸抑制、低血压、心动过缓、体动、呃逆)及术后(头晕、恶心呕吐、复视、分泌物增多、噩梦)不良反应的发生情况。记录4组患者环泊酚用量、追加环泊酚例数、使用麻黄碱例数及追加镇痛药例数。结果与C组比较,E1组、E2组、E3组mOAA/S≤1分时间较短(均P<0.05),E3组苏醒时间、离院时间较长(均P<0.05)。与E3组比较,E1组、E2组mOAA/S≤1分时间、苏醒时间、离院时间均较短(均P<0.05)。与C组比较,E1组、E2组、E3组环泊酚用量、使用麻黄碱例数、追加镇痛药例数较少(均P<0.05),E2组追加环泊酚例数较少(P<0.05),E2组、E3组术中呛咳、低血压发生率较低(均P<0.05);与E1组比较,E2组术中呛咳发生率较低,E2组、E3组术中低血压发生率较低(均P<0.05);与E2组比较,E3组术中呛咳发生率较高(P<0.05)。E3组术后头晕、分泌物增多、复视发生率高于E1组、E2组、C组(均P<0.05)。与T_(0)时比较:4组患者T_(4)~T_(5)时心率降低(均P<0.05),T_(1)~T_(5)时MAP、BIS降低,T_(1)~T_(2)时SpO_(2)降低,C组T_(1)~T_(5)时RR下降,E1组、E2组、E3组T_(1)~T_(2)时RR下降,T_(3)~T_(5)时RR升高(均P<0.05)。与C组比较:T_(1)~T_(2)时E1组、E2组、E3组SpO_(2)较高(均P<0.05);T_(1)~T_(5)时E1组、E2组、E3组BIS、RR较高(均P<0.05);T_(1)时E1组、E2组、E3组MAP,T_(2)~T_(4)时E2组、E3组MAP,T_(5)时E2组MAP较高(均P<0.05)。其余指标差异无统计学意义(均P>0.05)。结论艾司氯胺酮复合环泊酚可安全、有效地应用于门诊无痛胃肠镜检查,艾司氯胺酮可减轻环泊酚对循环及呼吸系统的抑制,艾司氯胺酮0.3 mg/kg是用于无痛胃肠镜检查的合适诱导剂量。

ObjectiveTo investigate the efficacy and safety of different doses of esketamine combined with ciprofol in patients undergoing painless gastrointestinal endoscopy.MethodsA total of 240 patients,aged 18-64 years,body mass index(BMI)of 18-30 kg/m^(2),American Society of Anesthesiologists(ASA)gradeⅠorⅡ,were selected for outpatient painless gastrointestinal endoscopy.Patients were divided into 4 groups according to random number table method(60 cases per group):esketamine 0.2 mg/kg group(group E1),esketamine 0.3 mg/kg group(group E2),esketamine 0.4 mg/kg group(group E3)and ciprofol single anesthesia group(group C).The groups E1,E2 and E3 were given intravenous in jection of 0.2,0.3 mg/kg and 0.4 mg/kg esketamine,and ciprofol was given 0.2-0.4 mg/kg after 30 s respectively,group C was given 0.4 mg/kg ciprofol intravenously.The mOAA/S≤1 min,examination time,recovery time and discharge time of 4 groups were recorded.The heart rate,pulse oxygen saturation(SpO_(2)),mean arterial pressure(MAP),respiratory rate(RR),bispectral index(BIS)values were recorded when the patients entered the room(T_(0)),immediately after entering the gastroscopy(T_(1)),immediately after gastroscopy(T_(2)),immediately after entering the endoscopy(T_(3)),when the endoscope reached the ileocecal part(T_(4)),at the end of the endoscopy(T_(5))and when awake(T_(6)).The occurrence of adverse reactions during operation(choking,respiratory depression,hypotension,bradycardia,movement,hiccup)and after operation(giddy,nausea and vomiting,diplopia,increased secretion,nightmares)were recorded in 4 groups.The dosage of ciprofol,the number of additional cases of ciprofol,the number of additional cases of ephedrine and the supplementary analgesic drugs were recorded in 4 groups.ResultsCompared with group C,the time of mOAA/S≤1 min in groups E1,E2 and E3 was shorter(all P<0.05),and the time of recovery and discharge from hospital in group E3 was longer(all P<0.05).Compared with group E3,mOAA/S≤1 min,recovery time and discharge time of groups E1 and E2 were shorter(all P<0.05).Compared with group C,the dosage of ciprofol,the number of ephedrine use cases and the number of additional analgesics cases in groups E1,E2 and E3 were lower(all P<0.05),the number of additional ciprofol cases in group E2 was lower(P<0.05).Compared with group C,the incidence of cough and hypotension was lower in groups E2 and E3(P<0.05).Compared with group E1,the incidence of intraoperative cough was lower in group E2,and the incidence of intraoperative hypotension was lower in groups E2 and E3(all P<0.05).Compared with group E2,the incidence of coughing was higher in group E3(P<0.05).The incidence of dizziness,increased secretion and diplopia in group E3 was higher than that in group E1,group E2 and group C(all P<0.05).Compared with T_(0):heart rate decreased at T_(4)-T_(5) in 4 groups(all P<0.05),MAP and BIS decreased at T_(1)-T_(5),SpO_(2) decreased at T_(1)-T_(2),RR decreased at T_(1)-T_(5) in group C,RR decreased at T_(1)-T_(2) in groups E1,E2 and E3;RR was increased from T_(3)-T_(5)(all P<0.05).Compared with group C:SpO_(2) in groups E1,E2 and E3 were higher at T_(1)-T_(2)(all P<0.05),BIS and RR in groups E1,E2 and E3 were higher at T_(1)-T_(5)(all P<0.05),and MAP in groups E1,E2,E3 were higher at T_(1),MAP in groups E2 and E3 were higher at T_(2)-T_(4),MAP in group E2 was higher at T_(5)(P<0.05).There was no significant difference in other indexes(all P>0.05).ConclusionsEsketamine combined with ciprofol can be safely used in outpatient painless gastroscopy.Compared with ciprofol alone,esketamine has the advantage of reducing the inhibition of circulatory and respiratory system,and the induction dose of 0.3 mg/kg esketamine is more appropriate.