机构地区:[1]无锡市妇幼保健院,江南大学附属妇产医院麻醉科,无锡214002
出 处:《国际麻醉学与复苏杂志》2024年第2期149-154,共6页International Journal of Anesthesiology and Resuscitation
基 金:无锡市卫健委重大科研项目(Z202211);无锡市妇幼健康适宜技术推广项目(FYTG202201)。
摘 要:目的观察不同剂量艾司氯胺酮联合丙泊酚在体外受精‑胚胎移植取卵术中的应用效果并筛选出其适宜剂量。方法120例择期行体外受精‑胚胎移植取卵术的患者,按随机数字表法分为3组(每组40例):艾司氯胺酮0.3 mg/kg组(S1组)、艾司氯胺酮0.4 mg/kg组(S2组)、艾司氯胺酮0.5 mg/kg组(S3组)。在其他麻醉相同基础上,3组患者术前1 min静脉注射相应剂量的艾司氯胺酮和丙泊酚1.0~1.5 mg/kg。记录3组患者麻醉前(T_(0))、麻醉诱导后1 min(T_(1))、取卵开始后5 min(T_(2))、苏醒时(T_(3))、苏醒后10 min(T_(4))的心率、平均动脉压(MAP)和脉搏血氧饱和度(SpO_(2)),丙泊酚用量及追加次数,苏醒时间,苏醒后清醒镇静(OAA/S)评分,苏醒后5 min、10 min、30 min时视觉模拟评分法(VAS)疼痛评分,苏醒后30 min内不良反应(幻觉、眩晕、呼吸抑制、恶心呕吐)发生情况。结果与T_(0)时比较,S1组、S2组T_(1)~T_(3)时心率、MAP降低(均P<0.05)。与S3组比较,S1组T_(1)~T_(3)时心率、MAP较低(均P<0.05),S2组T_(2)时心率及T_(2)、T_(3)时MAP较低(均P<0.05)。与S1组比较,S2组、S3组丙泊酚用量及追加次数较少(均P<0.05),苏醒时间较短(均P<0.05),苏醒后OAA/S评分较高(均P<0.05);与S2组比较,S3组丙泊酚用量及追加次数较少(均P<0.05),苏醒时间较短(P<0.05),苏醒后OAA/S评分较高(P<0.05)。与S1组比较,S2组、S3组苏醒后5 min VAS疼痛评分较低(均P<0.05)。S1组、S2组患者呼吸抑制发生率高于S3组(均P<0.05),S1组患者呼吸抑制发生率高于S2组(P<0.05);3组患者幻觉、眩晕、恶心呕吐发生率差异无统计学意义(均P>0.05)。结论对接受无痛取卵的患者,麻醉诱导时单次静脉注射0.5 mg/kg艾司氯胺酮是安全、有效的,可以减少丙泊酚用量,保持术中呼吸循环系统稳定,并且术后苏醒时间短,不良反应少。Objective To evaluate the application of different doses of esketamine combined with propofol for oocyte retrieval during in vitro fertilization‑embryo implantation and select proper doses.Methods A total of 120 patients who underwent elective oocyte retrieval for in vitro fertilization‑embryo implantation were selected.According to the random number table method,they were divided into three groups(n=40):an esketamine 0.3 mg/kg group(group S1),an esketamine 0.4 mg/kg group(group S2),and an esketamine 0.5 mg/kg group(group S3).The three groups were intravenously administered with the corresponding doses of esketamine and propofol at 1.0‒1.5 mg/kg 1 min before surgery,in addition to the same other anesthetic dosage schemes.Their heart rate,mean arterial pressure(MAP)and saturation of peripheral oxygen(SpO_(2))were recorded before anesthesia(T_(0)),1 min after anesthesia induction(T_(1)),5 min after the beginning of oocyte retrieval(T_(2)),at the time of awakening(T_(3)),and 10 min after awakening(T_(4)).Furthermore,the doses of propofol,the number of propofol doses administered,the postoperative recovery phrase,the Observer's Assessment Alert/Sedation(OAA/S)scores,and the Visual Analogue Scale(VAS)pain scores 5,10,30 min after awakening were recorded.Meanwhile,the incidences of adverse reactions,including hallucination,dizziness,respiratory depression,and nausea and vomiting within 30 min after awakening were recorded.Results Compared with those at T0,groups S1 and S2 showed decreases in heart rate and MAP at T_(1)‒T_(3)(all P<0.05).Compared with group S3,group S1 presented reduced heart rate and MAP at T_(1)‒T_(3)(all P<0.05),while group S2 showed reduced heart rate at T_(2) and decreased MAP at both T_(2) and T_(3)(all P<0.05).Compared with group S1,groups S2 and S3 presented decreases in the doses of propofol and number of propofol doses administered(all P<0.05),reduced postoperative recovery phrase(all P<0.05),and increases in OAA/S scores after awakening(all P<0.05).Compared with group S2,group S3 sh
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