亚麻醉剂量艾司氯胺酮复合丙泊酚在无痛胃镜检查中对低血压及低氧血症的影响

Effect of subanesthetic dose of esketamine combined with propofol on hypotension and hypoxemia in painless gastroscopy

摘要:

目的 探讨亚麻醉剂量艾司氯胺酮复合丙泊酚在无痛胃镜检查中对低血压和低氧血症的影响。方法 选取2023年4月－2024年3月在该院行择期无痛胃镜检查的患者179例，随机分为艾司氯胺酮组（艾司氯胺酮复合丙泊酚，EP组，90例）和对照组（舒芬太尼复合丙泊酚，SP组，89例）。EP组静脉注射艾司氯胺酮0.20 mg/kg，SP组静脉注射舒芬太尼0.10 μg/kg，两组均静脉注射丙泊酚1.50 mg/kg，在患者睫毛反射消失且深度镇静［改良警觉镇静评分（MOAA/S）≤ 1分］时，开始胃镜进镜操作，需要时追加0.50～1.00 mg/kg丙泊酚。记录两组患者围手术期指标（低血压及低氧血症等心肺不良事件的发生情况、丙泊酚总用量、麻醉诱导时间、麻醉诱导至进镜时间、胃镜检查时间、苏醒时间和恢复时间）；记录两组患者胃镜检查期间最低经皮动脉血氧饱和度（SpO₂）；记录两组患者麻醉诱导前（T₀）、胃镜置入前（T₁）、胃镜置入后3 min（T₂）、胃镜检查结束即刻（T₃）和出恢复室前（T₄）的平均动脉压（MAP）、心率（HR）和SpO₂；记录两组患者并发症发生率（恶心、呕吐、头晕和做梦）和患者满意度。结果 与SP组比较，EP组低血压和低氧血症发生率明显降低，胃镜检查期间最低SpO₂明显升高，丙泊酚用量增加，苏醒时间延长，差异均有统计学意义（P < 0.05）。两组患者诱导时间、麻醉诱导至进镜时间、胃镜检查时间和恢复时间比较，差异均无统计学意义（P > 0.05）。与T₀时点比较，T₁、T₂、T₃和T₄时点两组患者MAP均下降，且SP组下降更为明显；T₁时点，EP组患者HR较T₀时点升高，SP组T₂、T₃和T₄时点HR较T₀时点下降；T₂时点，两组患者SpO₂较T₀时点下降，差异均有统计学意义（P < 0.05）。与EP组比较，SP组T₁、T₂、T₃和T₄时点MAP和HR明显降低，T₂、T₃和T₄时点SpO₂明显降低，差异均有统计学意义（P < 0.05）。与SP组比较，EP组做梦者较多，但均未出现梦魇，两组患者检查后头晕、恶心和呕吐发生率，以及满意度比较，差异均无统计学意义（P > 0.05）。结论 亚麻醉剂量（0.20 mg/kg）艾司氯胺酮复合丙泊酚可安全有效地用于无痛胃镜检查，能减少低血压及低氧血症等心肺不良事件，维持患者血流动力学稳定，且不增加药物相关副作用。值得应用于临床。

Abstract:

Objective To explore the effect of subanesthetic dose of esketamine combined with propofol on hypotension and hypoxemia during painless gastroscopy.Methods A total of 179 patients who underwent elective painless gastroscopy from April 2023 to March 2024 were selected and randomly divided into the esketamine group (esketamine with propofol, EP group, 90 cases) and the control group (sufentanil combined with propofol, SP group, 89 cases). The EP group was intravenously injected with esketamine at a dose of 0.20 mg/kg, the SP group was intravenously injected with sufentanil at a dose of 0.10 μg/kg, and both groups were intravenously injected with propofol at a dose of 1.50 mg/kg. Gastroscopy was initiated when the patient's eyelash reflex disappeared and deep sedation [modified observer's assessment of alertness/sedation scale (MOAA/S) ≤1]. Add 0.50 to 1.00 mg/kg of propofol when necessary. The perioperative indicators of the two groups of patients (the occurrence of adverse cardiopulmonary events such as hypotension and hypoxemia, the total dosage of propofol, the time of anesthesia induction, the time anesthesia induction to endoscopy, the time of gastroscopy, the awakening time and the recovery time) and the lowest percutaneous arterial oxygen saturation (SpO₂) during gastroscopy were recorded. Record the mean arterial pressure (MAP), heart rate (HR), and SpO₂ of the two groups of patients before anesthesia induction (T₀), before gastroscopy implantation (T₁), 3 minutes after gastroscopy implantation (T₂), immediately after the end of gastroscopy (T₃), and before leaving the recovery room (T₄). Record the incidence of complications (nausea, vomiting, dizziness and dreaming) and patient satisfaction in the two groups of patients.Results Compared with the SP group, the incidence of hypotension and hypoxemia in the EP group was significantly lower, the lowest SpO₂ during gastroscopy was significantly higher, the dosage of propofol was increased, and the awakening time was prolonged. The differences were statistically significant (P < 0.05). There were no statistically significant differences in time of anesthesia induction, anesthesia induction to endoscopy, gastroscopy examination and recovery between the two groups of patients (P > 0.05). Compared with the T₀ time point, the MAP of patients in both groups decreased at T₁, T₂, T₃ and T₄ time points, and the decrease was more obvious in the SP group. At T₁ time point, the HR of patients in the EP group was higher than that at T₀ time point, while the HR at T₂, T₃ and T₄ time points in the SP group was lower than that at T₀ time point. At T₂ time point, SpO₂ in both groups of patients decreased compared with that at time point T₀, and the differences were statistically significant (P < 0.05). Compared with the EP group, MAP and HR at time points T₁, T₂, T₃ and T₄ in the SP group were significantly decreased, and SpO₂ at time points T₂, T₃ and T₄ was significantly decreased. The differences were statistically significant (P < 0.05). Compared with the SP group, the EP group had more dreamers, but none of them had nightmares. There were no statistically significant differences in the incidence of dizziness, nausea and vomiting after examination, as well as satisfaction between the two groups (P > 0.05).Conclusion The subanesthetic dose (0.20 mg/kg) of esketamine combined with propofol can be safely and effectively used in painless gastroscopy, reducing the incidence of adverse cardiopulmonary events such as hypotension and hypoxemia, maintaining hemodynamic stability in patients, and not increasing drug-related side effects. It is worth applying in clinical practice.