氯胺酮复合麻醉方案在肥胖患者无痛胃镜检查中的应用  

Effect and Safety of Ketamine Combined Anesthesia Regimen in Painless Gastroscopy for Patients with Obesity

作　　者：郑世红 王建松[2] 王海霞 张杰[3] 崔林 Zheng Shihong;Wang Jiansong;Wang Haixia;Zhang Jie;Cui Lin(Digestive System Department,Fourth People's Hospital of Langfang City/Afiliated Hospital of Chengde Medical College,Langfang 065700,Hebei,China;Anesthesiology Department,Fourth People's Hospital of Langfang City/Afiliated Hospital of Chengde Medical College,Langfang 065700,Hebei,China;Endoscopy Division,Fourth People's Hospital of Langfang City/Afiliated Hospital of Chengde Medical College,Langfang 065700,Hebei,China;Clinical Laboratory,Fourth People's Hospital of Langfang City/Afiliated Hospital of Chengde Medical College,Langfang 065700,Hebei,China)

机构地区：[1]廊坊市第四人民医院/承德医学院附属医院消化内科,河北廊坊065700 [2]廊坊市第四人民医院/承德医学院附属医院麻醉科,河北廊坊065700 [3]廊坊市第四人民医院/承德医学院附属医院内镜科,河北廊坊065700 [4]廊坊市第四人民医院/承德医学院附属医院检验科,河北廊坊065700

出　　处：《药物流行病学杂志》2022年第9期586-590,共5页Chinese Journal of Pharmacoepidemiology

基　　金：廊坊市科学技术研究与发展计划项目(编号:2019013029)。

摘　　要：目的:探讨小剂量氯胺酮复合瑞芬太尼、丙泊酚、依托咪酯及达克罗宁麻醉在肥胖患者无痛胃镜检查中的应用价值。方法:128例拟行无痛胃镜检查的肥胖患者随机分为对照组与观察组各64例。对照组接受静脉输注瑞芬太尼0.5μg·kg^(-1)、丙泊酚1.0~2.0 mg·kg^(-1)、依托咪酯0.10~0.15 mg·kg^(-1)及达克罗宁口服方案;观察组在对照组基础上增加静脉输注氯胺酮5~10 mg。比较两组麻醉优良率、麻醉诱导时间、胃镜检查时间、清醒时间、丙泊酚总用量,以及患者满意度、内镜医师满意度、麻醉医师满意度。观察两组患者术中不同时点的平均动脉压(MAP)、心率(HR)、氧饱和度(SpO)等指标变化;记录药品不良反应发生情况。结果:观察组麻醉优良率为96.9%,明显高于对照组的85.9%(P<0.05);观察组麻醉诱导时间、清醒时间及丙泊酚总用量均低于对照组(P<0.05),两组检查时间无明显差异(P>0.05)。观察组的患者满意度、内镜医师满意度、麻醉医师满意度评分均高于对照组(P<0.05)。两组患者自麻醉药静注结束至检查结束时的HR、MAP、SpO均较本组入室时下降(P<0.05),且在胃镜经过会厌、麻醉后3 min、检查结束时,观察组的HR、MAP、SpO均高于对照组(P<0.05)。观察组体动、呛咳、低血压、呼吸抑制发生率均低于对照组(P<0.05),两组患者均未发生过敏。结论:小剂量氯胺酮与瑞芬太尼、丙泊酚、依托咪酯及达克罗宁联合应用的麻醉方案,用于肥胖患者无痛胃镜检查的效果良好、安全性高。Objective:To explore the application value of low-dose ketamine combined with remifentanil, propofol, etomidate and dacronine anesthesia in painless gastroscopy for obese patients. Methods:One hundred and twenty-eight patients with obesity who planned to undergo painless gastroscopy were randomly divided into control group and observation group, with sixty-four patients in each group. The control group received intravenous infusion of remifentanil 0.5 g·kg^(-1) , propofol 1.0-2.0 mg·kg^(-1) and etomidate 0.10-0.15 mg·kg^(-1) and oral administration of dacronine, the observation group was given 5-10 mg ketamine intravenously on the basis of the control group. The excellent and good anesthesia rate, anesthesia induction time, gastroscopy time, awake time, total propofol dosage, patient satisfaction, endoscope satisfaction and anesthesiologist satisfaction were compared between the two groups. The changes of MAP, HR, SpOduring operation were observed. The occurrence of adverse reactions during the operation was recorded.Results:The excellent and good rate of anesthesia in the observation group(96.9%), which was higher than that in the control group(85.9%)(P<0.05). The induction time, waking time and total propofol dosage in the observation group were lower than that in the control group(P<0.05), and there was no significant difference in the examination time between the two groups(P>0.05). The satisfaction of patients, endoscopists and anesthesiologists in the observation group was higher than that in the control group(P<0.05). HR, MAP and SpOfrom the end of intravenous injection of anesthetics to the end of examination were significantly decreased than those at the time of entry into anaesthesia room in the two groups(P<0.05). HR, MAP and SpOin the observation group were higher than those in the control group after epiglottis, 3 min after anesthesia and at the end of examination(P<0.05). The incidence of body movement, cough, hypotension and respiratory depression in the observation group was lower than that in

关 键 词：胃镜 肥胖患者 麻醉 氯胺酮 丙泊酚 瑞芬太尼 依托咪酯 达克罗宁 

分 类 号：R971.2[医药卫生—药品]