艾司氯胺酮复合丙泊酚在无痛人工流产手术中的应用

Application of esketamine with propofol in patients undergoing painless abortion

目的:探讨艾司氯胺酮复合丙泊酚对无痛人工流产患者术后疼痛、焦虑和抑郁情绪及睡眠质量的影响。方法:纳入择期行无痛人工流产术患者80例,采用随机数字表法将所有患者分为艾司氯胺酮复合丙泊酚组(EP组)及丙泊酚组(P组)两组。麻醉诱导时EP组静脉推注艾司氯胺酮0.25 mg/kg+丙泊酚1.0 mg/kg,P组静脉推注丙泊酚2.5 mg/kg。观察两组患者不同时间点的MAP、HR及SpO 2;记录手术时长、苏醒时间、术中追加丙泊酚次数和总用量、托下颌次数、疼痛视觉模拟量表(VAS)评分;分别于术前和术后4周采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)及匹兹堡睡眠质量指数(PSQI)评估患者的焦虑抑郁情绪和睡眠质量;比较两组不良反应发生率。结果:EP组患者术毕苏醒后5 min VAS评分(1.30±0.66)较P组(2.71±0.61)降低(P<0.001)。两组患者术后4周HAMA、HAMD及PSQI评分均较术前降低,且EP组患者HAMA、HAMD及PSQI评分下降幅度均优于P组(P<0.05)。EP组术中体动、托下颌发生率低于P组,但术后头晕发生率高于P组(P<0.05)。与P组比较,EP组丙泊酚总用量减少、术者满意度更高(P<0.05)。结论:艾司氯胺酮复合丙泊酚静脉麻醉能够减轻无痛人工流产患者术后疼痛,缓解焦虑和抑郁情绪并改善术后睡眠质量,且不良反应轻。

Objective:To observe the effects of esketamine combined with propofol on postoperative pain,anxiety,depression and sleep quality in patients with painless abortion.Methods:Eighty women undergoing selective painless abortion were included,and allocated to esketamine+propofol group(group EP)and propofol group(group P)by random number table method.Patients in group P received 2.5 mg/kg propofol intravenous injection during anesthesia induction,and those in group EP were intravenously administered with esketamine 0.25 mg/kg+propofol 1.0 mg/kg during anesthesia induction.MAP,HR and SpO 2 of the two groups were observed at different time points.The duration of operation,recovery time,additional doses and total dosage of propofol,the number of mandibular support and the visual analogue scale(VAS)score were maintained in both groups.Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD)and Pittsburgh Sleep Quality Index(PSQI)were used to evaluate the anxiety,depression and sleep quality of the patients before operation and 4 weeks after surgery.The incidence of adverse reactions was compared between the two groups.Results:The VAS scores at 5 min after awakening in group EP(1.30±0.66)were lower than those in group P(2.71±0.61;P<0.001).The HAMA,HAMD and PSQI score were decreased at 4 weeks following surgery in both groups,an the decrease was more obvious in group EP than in group P(P<0.05).The incidence of intraoperative body movement and mandibular support were lower and the postoperative dizziness was higher in group EP than those in group P(P<0.05).Compared with group P,the total dosage of propofol was decreased and satisfaction with the operators were higher in group EP(P<0.05).Conclusion:Esketamine plus propofol intravenous anesthesia can alleviate postoperative pain,relieve anxiety and depression,and improve postoperative sleep quality in patients with painless abortion.The adverse reaction appears mild.