目的 探讨小剂量艾司氯胺酮在肥胖患者无痛胃镜诊疗中的有效性及安全性。方法 选取2021-09至2022-06西部战区总医院行无痛胃镜诊疗的肥胖患者120例,随机分为两组,各60例。A组术前给予艾司氯胺酮0.2 mg/kg,B组给予舒芬太尼0.1 μg/kg,后给予丙泊酚1~2 mg/kg。比较两组麻醉前(T1)、胃镜插入时(T2)、术毕即刻(T3)、术毕10 min(T4)的心率(HR)、平均动脉压(MAP)、氧饱和度(SpO2)、呼吸频率(RR);记录术中呛咳、体动、操作停止及活血管药物的应用情况;记录两组操作时间、苏醒时间、丙泊酚用量;术后恶心呕吐、谵妄及操作医师对麻醉效果的评优例数。结果 B组患者T2、T3时的 HR、MAP、RR、SpO2较T1时明显降低,且明显低于A组(P<0.05); A组术中呛咳、体动、操作停止以及运用活血管药物例数明显少于B组;A组丙泊酚用量明显少于B组,操作时间也短于B组,操作医师的评优例数多于B组(P<0.05);而两组的苏醒时间、术后恶心呕吐及谵妄例数无统计学差异(P>0.05)。结论 小剂量艾司氯胺酮用于肥胖患者胃镜诊疗中,循环更稳定,呼吸抑制少,麻醉效果更满意,更安全有效。
Abstract
Objective To investigate the efficacy and safety of low-dose esketamine in painless diagnosis in obese patients. Methods A total of 120 obese patients undergoing painless gastroscopy in General Hospital of Western Theater Command from September 2021 to June 2022 were randomly divided into two groups, with 60 cases in each group. Group A was given esketamine 0.2 mg/kg, group B was given sufentanil 0.1 μg/kg before operation, and then propofol 1-2 mg/kg was given. Heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO2) were compared between the two groups before anesthesia (T1), at the time of gastroscopy insertion (T2), at the end of surgery (T3), and 10 minutes after operation.Respiratory rate (RR), the number of cases of intraoperative cough, body movement, operation stop and application of viable vessels were recorded. The operation time, awakening time and propofol dosage of the two groups were recorded. The number of postoperative nausea, vomiting, delirium and the evaluation by the operator on the effect of anesthesia were also recorded. Results HR, MAP, RR and SpO2 of group B at T2 and T3 were significantly lower than those at T1, and were significant lower than those of group B (P<0.05). The cases of intraoperative cough, body movement, operation stop and use of vasoactive drugs in group A were significantly lower than those in group B (P<0.05). The dosage of propofol in group A was significantly less than that in group B. The operation time of group A was shorter than that of group B; the number of operators’ good evaluation cases was higher than that of group B (P<0.05).There were no significant differences in recovery time, postoperative nausea and vomiting or deliration cases between the two groups (P>0.05). Conclusions Low-dose esketamine used in the gastroscopy of obese patients is more safe and effective, which is characterized by more stable circulation, less respiratory depression and more satisfactory anesthetic effect.
关键词
艾司氯胺酮 /
舒芬太尼 /
丙泊酚 /
肥胖 /
无痛胃镜
Key words
esketamine /
sufentanil /
propofol /
obesity /
painless gastroscope
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