小剂量艾司氯胺酮联合丙泊酚/依托咪酯混合液在无痛胃镜麻醉中的应用效果分析  

Efficacy of low-dose esketamine combined with propofol/etomidate mixture in painless gastroscopy anesthesia

作　　者：胡德生 郑建武 叶夏玉 De-Sheng Hu;Jian-Wu Zheng;Xia-Yu Ye(Department of Anesthesiology,Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou 310007,Zhejiang Province,China;Department of Anesthesiology of the People’s Liberation Army 96601 Hospital,Huangshan 245000,Anhui Province,China;Operating Room of Meizhong Yihe Women’s and Children’s Hospital,Hangzhou 310007,Zhejiang Province,China)

机构地区：[1]杭州市中医院麻醉科,浙江省杭州市310007 [2]解放军96601部队医院麻醉科,安徽省黄山市245000 [3]美中宜和妇儿医院手术室,浙江省杭州市310007

出　　处：《世界华人消化杂志》2025年第4期299-307,共9页World Chinese Journal of Digestology

摘　　要：背景丙泊酚/依托咪酯混合液是无痛胃镜检查常用麻醉药物,麻醉效果欠佳.艾司氯胺酮能取得理想的麻醉效果,小剂量具有更可靠的安全性.但小剂量艾司氯胺酮联合丙泊酚/依托咪酯混合液在无痛胃镜麻醉中的应用尚少.目的探讨小剂量艾司氯胺酮联合丙泊酚/依托咪酯混合液在无痛胃镜麻醉中的应用效果.方法选取杭州市中医院2023-06/2024-06拟行无痛胃镜检查患者进行前瞻性研究,按照随机数字表法分为常规组与联合组.常规组给予丙泊酚/依托咪酯混合液,联合组在常规组基础上给予小剂量艾司氯胺酮.比较两组麻醉效果、入室时(T_(1))、开始镇静时(T_(2))、置入胃镜时(T_(3))、撤出胃镜时(T_(4))、操作结束时(T_(5))血流动力学[心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)]、呼吸指标[呼吸频率(respiratory rate,RR)、动脉血氧饱和度]、苏醒后15 min、30 min认知功能[简易智力状态检查量表(Mini Mental State Examination,MMSE)评分]及不良反应(恶心呕吐、低血压、呼吸抑制、术后谵妄)发生率.结果联合组麻醉起效时间、苏醒时间、麻醉后监护室停留时间短于常规组,麻醉药物追加次数、追加麻醉药物总量少于常规组(P<0.05);两组不同时点HR、MAP、RR交互效应差异有统计学意义(P<0.05);单因素重复测量方差分析组内效应显示:两组T_(1)-T_(2)时HR、MAP、RR无明显变化(P>0.05),T_(3)-T_(5)时HR呈先升高后下降趋势,MAP呈先下降后升高趋势(P<0.05),常规组T_(3)-T_(5)时RR呈下降趋势(P<0.05);多变量方差分析组间效应显示:联合组T_(3)-T_(5)时HR低于常规组,MAP、RR高于常规组(P<0.05);广义估计方程模型单因素及多因素分析结果显示,HR、MAP、RR在组别、时间及两者的交互项中差异有统计学意义(P<0.05);联合组苏醒后15 min、苏醒后30 min MMSE评分高于常规组(P<0.05);联合组呼吸抑制、谵妄发生率低于常规组(P<0.05).结论BACKGROUND Propofol/etomidate mixture is a common anesthetic for painless gastroscopy,but the anesthetic effect is not satisfactory.Esmketamine can achieve ideal anesthetic effect,and low-dose esmketamine has more reliable safety.However,the application of low-dose esmketamine combined with propofol/etomidate mixture in painless gastroscopy anesthesia has been less explored.AIM To evaluate the efficacy of low-dose esketamine combined with propofol/etomidate mixture in painless gastroscopy anesthesia.METHODS A prospective study was conducted on patients who were scheduled to undergo painless gastroscopy at the Hangzhou Traditional Chinese Medicine Hospital from June 2023 to June 2024.They were randomly divided into a control group and a combination group according to the random number table method.Both groups were given a mixture of propofol and etomidate,and the combination group was additionally given a low dose of esketamine.The anesthesia effects and incidence of adverse reactions(nausea and vomiting,hypotension,respiratory depression,and postoperative delirium)were compared between the two groups,as well as hemodynamic parameters[heart rate(HR)and mean arterial pressure(MAP)],respiratory parameters[respiratory rate(RR),arterial oxygen saturation]at the time of entering the room(T_(1)),starting sedation(T_(2)),inserting the gastroscope(T_(3)),withdrawing the gastroscope(T_(4)),and at the end of the operation(T_(5)),and cognitive function[mini-mental state examination(MMSE)score]at 15 min and 30 min after awakening.RESULTS The time to onset of anesthesia,time to recovery,and post-anesthesia care unit stay time in the combination group were shorter than those of the control group,and the number of additional anesthetic drugs and the total amount of additional anesthetic drugs used were less than those of the control group(P<0.05).The interaction effect of HR,MAP,and RR at different time points between the two groups was statistically significant(P<0.05).At T_(1)-T_(2),the inter-group effects of the univariate re

关 键 词：无痛胃镜 麻醉 艾司氯胺酮 丙泊酚/依托咪酯混合液 呼吸抑制 谵妄 

分 类 号：R614[医药卫生—麻醉学]