环泊酚联合艾司氯胺酮麻醉用于支气管内超声检查的安全性研究  

Study on the safety of anesthesia with ciprofol combined with esketamine in EBUS examination

作　　者：王龙江 庞轩 郑紫晨 丁文平[3] 王艳飞 王宇浪 贾梦醒 Wang Longjiang;Pang Xuan;Zheng Zichen;Ding Wenping;Wang Yanfei;Wang Yulang;Jia Mengxing(College of Anesthesiology,Xuzhou Medical University,Xuzhou 221006,China;Department of Anesthesiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China;Department of Anesthesiology,Xuzhou Central Hospital,Xuzhou 221006,China)

机构地区：[1]徐州医科大学麻醉学院,江苏徐州221006 [2]徐州医科大学附属医院麻醉科,江苏徐州221006 [3]徐州市中心医院麻醉科,江苏徐州221006

出　　处：《实用药物与临床》2024年第7期525-531,共7页Practical Pharmacy and Clinical Remedies

基　　金：徐州市卫生健康委员会科技项目青年项目(XWKYHT20220088)。

摘　　要：目的探讨环泊酚联合艾司氯胺酮麻醉在支气管内超声(EBUS)检查中应用的有效性与安全性。方法选取2023年5月至10月于徐州医科大学附属医院择期行EBUS检查的患者160例,美国麻醉医师协会(ASA)Ⅰ~Ⅲ级,年龄18~75岁,体重指数(BMI)18~28 kg/m^(2),采用随机数字表将患者分为丙泊酚组(P组)、丙泊酚+艾司氯胺酮组(PE组)、环泊酚组(C组)与环泊酚+艾司氯胺酮组(CE组),每组40例。麻醉诱导时,PE、CE组额外给予艾司氯胺酮0.3 mg/kg;麻醉维持时,P组、PE组使用丙泊酚3~6 mg/(kg·h)持续泵注,C组、CE组使用环泊酚0.6~1.2 mg/(kg·h)持续泵注,维持脑电双频指数(BIS)值在40~60之间。记录四组在麻醉诱导前(T_(1))、喉罩置入后(T_(2))、气管镜通过声门时(T_(3))、检查10 min时(T_(4))、检查结束时(T_(5))、返回病房时(T_(6))患者的平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO_(2))、BIS,记录麻醉时间、手术时间、苏醒时间,记录镇痛镇静药物用量、低血压发生率及术后不良反应等,并于术后24 h进行QoR-40问卷评分,评估患者术后早期的恢复质量。结果P组、PE组、C组和CE组患者低血压的发生率分别为52.5%、37.5%、40.0%、20.0%,差异有统计学意义(P=0.027)。Logistic回归显示,与使用丙泊酚比较,使用环泊酚与艾司氯胺酮是术中低血压的保护因素(OR=0.512,95%CI:0.264~0.993,P=0.048;OR=0.460,95%CI:0.237~0.893,P=0.022)。四组术后24 h QoR-40问卷总分比较,差异有统计学意义(P<0.001)。PE组、CE组身体舒适度、情绪状态及疼痛评分与P组比较,差异有统计学意义(P<0.05),C组身体舒适度及疼痛评分与P组比较,差异有统计学意义(P<0.05)。四组患者低血压及注射痛发生率比较,差异有统计学意义(P<0.05)。结论环泊酚单独使用或与艾司氯胺酮联用能改善EBUS检查患者术后早期恢复质量,减少术中低血压的发生及低血压的严重程度,可以安全用于超声支气管镜检查。Objective To investigate the validity and safety of anesthesia with ciprofol combined with esketa mine in endobronchial ultrasound(EBUS)examination.Methods Totally 160 patients(ASA Ⅰ~Ⅲ,aged 18~75 years,BMI 18~28 kg/m2)who underwent EBUS examination at the Affiliated Hospital of Xuzhou Medical University from May to October 2023 were selected and divided into four groups by random number table method:propofol group(group P),propofol+esketamine group(group PE),ciprofol group(group C),and ciprofol+esketamine group(group CE),with 40 cases in each group.During anesthesia induction,groups PE and CE were given an additional 0.3 mg/kg of esketamine.During anesthesia maintenance,propofol 3~6 mg/(kg·h)was used in groups P and PE,and ciprofol 0.6~1.2 mg/(kg·h)was used in groups C and CE to maintain the bispectral index(BIS)value of 40~60.The mean arterial pressure(MAP),heart rate(HR),pulse oxygen saturation(SpO_(2))and the BIS of patients were recorded before anesthesia induction(T_(1)),after laryngeal mask placement(T_(2)),at the time of tracheoscopy through the glottis(T_(3)),at 10 min after examination(T_(4)),at the end of examination(T_(5)),and at the time of returning to the ward(T_(6)).The anesthesia time,operation time,regaining consciousness time,dosage of analgesic and sedative drugs,incidence of hypotension and postoperative adverse reactions were recorded.QoR-40 questionnaire scoring was performed 24 h after surgery to evaluate the quality of early postoperative recovery of patients.Results The incidence rates of hypotension in group P、group PE、group C and group CE were 52.5%,37.5%,40%and 20.0%(P=0.027).Logistic regression showed that the use of ciprofol and esketamine was a protective factor for intraoperative hypotension(OR=0.512,95%CI:0.264~0.993,P=0.048;OR=0.460,95%CI:0.237~0.893,P=0.022),as compared to the use of propofol.There were significant differences in QoR-40 scores at 24 h after operation among the four groups(P<0.001).There were significant differences in scores of physical comfort,emotion

关 键 词：环泊酚 艾司氯胺酮 丙泊酚 支气管内超声检查 低血压 

分 类 号：R614[医药卫生—麻醉学]