艾司氯胺酮复合环泊酚在老年患者结肠镜检查去阿片化麻醉中的应用

Application of opioid-free anesthesia with Esketamine and Ciprofol for the elderly underwent colonoscopy

摘要:

目的 初步探讨艾司氯胺酮复合环泊酚用于老年患者结肠镜检查去阿片化麻醉的效果。方法 选择该院行无痛结肠镜检查的患者160例，随机分为艾司氯胺酮组（E组，n = 80）和舒芬太尼组（S组，n = 80）。E组静脉注射艾司氯胺酮0.2 mg/kg，S组静脉注射舒芬太尼0.1 μg/kg。然后两组均静脉注射环泊酚0.2 mg/kg。记录诱导前平静时（T₀）、诱导后改良警觉/镇静（MOAA/S）评分为0分时（T₁）、结肠镜通过肝曲时（T₂）和检查结束撤出结肠镜后（T₃）各时点平均动脉压（MAP）、心率（HR）和经皮动脉血氧饱和度（SpO₂）；并记录麻醉诱导时间、完全清醒时间、麻醉成功率、环泊酚追加剂量、满意度评分和不良反应发生率。结果 与T₀时点比较，两组患者T₁、T₂和T₃时点MAP降低；E组T₁时点HR降低，S组T₁、T₂和T₃时点HR降低；S组T₁和T₂时点SpO₂降低，差异均有统计学意义（P < 0.05）。与T₁时点比较，两组T₂时点MAP和HR升高，差异均有统计学意义（P < 0.05）。与E组比较，S组T₁、T₂和T₃时点MAP降低，T₁和T₂时点HR和SpO₂降低，差异均有统计学意义（P < 0.05）。与E组比较，S组环泊酚追加剂量、低氧血症发生率和低血压发生率增加，麻醉医师满意度降低，差异均有统计学意义（P < 0.05）。结论 艾司氯胺酮去阿片化麻醉用于老年患者结肠镜麻醉，低氧血症和低血压发生率低，安全可行。

Abstract:

Objective To observe the effect of opioid-free anesthesia with esketamine and ciprofol for the elderly underwent colonoscopy.Methods 160 elderly patients underwent colonoscopy were included in this study. Those patients were assigned to esketamine combined with ciprofol group (group E, n = 80) and sufentanil combined with ciprofol (group S, n = 80). Patients were intravenously injected respectively with esketamine 0.2 mg/kg in group E and sufentanil 0.1 μg/kg in group S. Then, all the patients were intravenously injected with ciprofol (0.2 mg/kg). Mean arterial pressure (MAP), heart rate (HR) and percutaneous arterial oxygen saturation (SpO₂) were recorded before injection of test drug (T₀), when modified observer’s assessment of alertness/sedation (MOAA/S) score was 0 points (T₁), when colonoscopy through hepatic flexure (T₂) and colonoscopy was removed after examination (T₃). The induction time of anesthesia, time of fully awake, rate of successful anesthesia, additional dose of ciprofol, satisfaction score and incidence of adverse events were recorded.Results Compared with T₀, MAP at T₁, T₂ and T₃ in two groups was decreased, HR at T₁ in group E, HR at T₁, T₂ and T₃ in group S and SpO₂ at T₁ and T₂ in group S were decreased, the differences were statistically significant (P < 0.05). Compared with T₁, MAP and HR at T₂ in two groups were increased, the differences were statistically significant (P < 0.05). Compared with group E, MAP in group S at T₁, T₂ and T₃, HR and SpO₂ at T₁ and T₂ in group E were decreased, the differences were statistically significant (P < 0.05). Compared with the group E, the additional dosage of ciprofol, the incidence of hypoxemia and hypotension were increased, the satisfaction of anesthesiologists was decreased in group S, the differences were statistically significant (P < 0.05).Conclusion For opioid-free anesthesia, esketamine is feasible for colonoscopy anesthesia in elderly patient, and the incidence of hypoxemia and hypotension is low.