不同剂量艾司氯胺酮联合丙泊酚用于老年患者内镜逆行胰胆管造影术的麻醉效果

Anesthetic effect of different doses of esketamine combined with propofol for endoscopic retrograde cholangiopancreatography in elderly patients

摘要:

目的 比较不同剂量艾司氯胺酮联合丙泊酚用于老年患者内镜逆行胰胆管造影术（ERCP）的麻醉效果，并探讨其适宜剂量。方法 选择择期行ERCP的老年患者105例，采用随机数表法，将患者分为E1组、E2组和E3组，各35例。E1组、E2组和E3组分别给予艾司氯胺酮0.20、0.35和0.50 mg/kg，静推15 s后，均给予丙泊酚1.00 mg/kg静脉注射。记录患者摆好左侧卧位后（T₀）、诱导成功时（T₁）、内镜置入喉部时（T₂）、括约肌置管或切开时（T₃）和苏醒时（T₄）的心率（HR）、平均动脉压（MAP）和经皮动脉血氧饱和度（SpO₂）。记录手术时间、术中丙泊酚用量、麻醉恢复时间和麻醉恢复后15 min静息时视觉模拟评分法（VAS）评分和不良反应发生情况。结果 与T₀时点比较，E1组T₁、T₂、T₃和T₄时点HR和MAP降低，E3组T₁、T₂、T₃和T₄时点HR和MAP升高，差异均有统计学意义（P < 0.05）；E2组T₁、T₂、T₃和T₄时点HR和MAP无明显变化（P > 0.05）；与E3组比较，E1组和E2组T₁、T₂、T₃和T₄时点HR和MAP较低，且E1组明显低于E2组，差异均有统计学意义（P < 0.05）；3组患者各时点SpO₂比较，差异均无统计学意义（P > 0.05）；与E1组比较，E2组和E3组丙泊酚用量减少，且E3组明显少于E2组，差异均有统计学意义（P < 0.05）；与E3组比较，E1组和E2组苏醒时间较短，且E2组较E1组短，差异均有统计学意义（P < 0.05）；与E1组比较，E2组和E3组苏醒后15 min疼痛VAS评分较低，且E3组较E2组低，差异均有统计学意义（P < 0.05）；3组患者手术时间比较，差异无统计学意义（P > 0.05）；E1组低氧血症、呼吸抑制和低血压发生率明显高于E2组和E3组（P < 0.05），E3组拟精神症状和视觉障碍发生率明显高于E1组和E2组，差异均有统计学意义（P < 0.05）；3组患者头晕和恶心呕吐发生率比较，差异均无统计学意义（P > 0.05）。结论 0.35 mg/kg的艾司氯胺酮复合丙泊酚应用于老年患者ERCP，呼吸循环更稳定，且未增加不良反应发生率。

Abstract:

Objective To compare the anesthetic effect of different doses of esketamine combined with propofol in elderly patients underwent endoscopic retrograde cholangiopancreatography (ERCP), and explore the appropriate dose.Methods 105 elderly patients were selected for ERCP. The patients were divided into 3 groups with 35 cases in each group by random number table method. E1 group, E2 group and E3 group were given esketamine 0.15, 0.35 and 0.50 mg/kg, respectively, and were given propofol 1.00 mg/kg intravenous injection 15 s later. Heart rate (HR), mean arterial pressure (MAP), and percutaneous arterial oxygen saturation (SpO₂) were recorded after left lateral position (T₀), at successful induction (T₁), endoscope through larynx (T₂), sphincter insertion or incision (T₃), and at recovery (T₄). Operation duration, intraoperative propofol dosage, anesthesia recovery time ,visual analogue scale (VAS) score 15 min after anesthesia recovery and occurrence of adverse reactions were recorded.Results Compared with T₀, HR and MAP decreased at T₁, T₂, T₃ and T₄ time point in E1 group, HR and MAP increased at T₁, T₂, T₃ and T₄ time point in E3 group, the differences were statistically significant (P < 0.05); HR and MAP had no significant changes at T₁, T₂,T₃ and T₄ time point in E2 group (P > 0.05); Compared with group E3, HR and MAP decreased at T₁, T₂, T₃ and T₄ time point in E1 group and E2 group, and E1 group was lower than E2 group, the differences were statistically significant (P < 0.05); There were no significant difference in SpO₂ at different time points between the three groups (P > 0.05); Compared with E1 group, the dosage of propofol in E2 group and E3 group was decreased, and E3 group was significantly less than E2 group, with statistical significance (P < 0.05). Compared with E3 group, the recovery time of E1 group and E2 group was shorter, and E2 group was shorter than E1 group, the differences were statistically significant (P < 0.05). Compared with E1 group, pain VAS score 15 min after recovery in E2 group and E3 group was lower, and E3 group was lower than E2 group, the differences were statistically significant (P < 0.05). There was no significant difference in operation time among 3 groups (P > 0.05). The incidence of hypoxemia, respiratory depression and hypotension in E1 group were higher than that in E2 group and E3 group, the difference was statistically significant (P < 0.05). The incidence of psychomimetic symptoms and visual disturbance in E3 group was higher than that in E1 group and E2 group, the difference was statistically significant (P < 0.05). There were no significant differences in the incidence of dizziness and nausea vomiting among the 3 groups (P > 0.05).Conclusion 0.35 mg/kg esketamine combined with propofol in the operation of ERCP in elderly patients, respiratory circulation is more stable, and adverse reactions do not increase.