环泊酚复合艾司氯胺酮或瑞芬太尼用于肥胖患者无痛胃镜和结肠镜检查的临床研究

Clinical study of ciprofol combined with esketamine or remifentanil in painless gastroscopy and colonoscopy for obese patients

摘要:

目的 对比环泊酚复合艾司氯胺酮或瑞芬太尼在肥胖患者无痛胃镜和结肠镜检查中的应用效果和安全性。方法 选择2024年1月－2024年10月该院收治的因腹痛或大便不成型入院，拟行无痛胃镜联合结肠镜检查的肥胖患者126例，采用随机数表法分为观察组和对照组，各63例。观察组麻醉镇痛方案采用环泊酚复合艾司氯胺酮，对照组采用环泊酚复合瑞芬太尼。比较两组患者不同时点［麻醉诱导前即刻（T₀）、麻醉诱导完成即刻（T₁）、胃镜过喉部时（T₂）、结肠镜过肝曲时（T₃）和检查结束即刻（T₄）］血流动力学指标［心率（HR）、经皮动脉血氧饱和度（SpO₂）和平均动脉压（MAP）］。比较两组患者麻醉相关情况（胃镜和结肠镜检查时间、麻醉诱导时间、麻醉苏醒时间和离院时间）。比较两组患者环泊酚消耗量、血管活性药物使用情况和不良反应发生情况；比较两组患者苏醒时、苏醒后30 min静息时疼痛视觉模拟评分法（VAS）评分，以及患者和麻醉医师的满意度评分。结果 两组患者MAP、HR和SpO₂的时间、组间和交互效应比较，差异均有统计学意义（P < 0.05）。观察组T₁、T₂、T₃和T₄时点MAP和HR明显高于对照组，T₁、T₂和T₃时点SpO₂明显高于对照组，差异均有统计学意义（P < 0.05）。观察组T₁、T₂和T₃时点MAP明显低于T₀时点，T₃时点HR明显低于T₀时点，差异均有统计学意义（P < 0.05）；对照组T₁、T₂、T₃和T₄时点MAP和HR明显低于T₀时点，T₁、T₂和T₃时点SpO₂明显低于T₀时点，差异均有统计学意义（P < 0.05）。两组患者胃镜和结肠镜检查时间、麻醉诱导时间、麻醉苏醒时间和离院时间比较，差异均无统计学意义（P > 0.05）。观察组环泊酚麻醉诱导消耗量、维持消耗量和总消耗量明显少于对照组，血管活性药物使用率明显低于对照组，差异均有统计学意义（P < 0.05）。观察组呼吸抑制（0.00%）、低血压（1.59%）和心动过缓（0.00%）发生率明显低于对照组（9.52%、12.70%和11.11%），差异均有统计学意义（P < 0.05），两组患者气道梗阻、恶心呕吐、头晕头痛、注射痛、呛咳和体动发生率比较，差异均无统计学意义（P > 0.05）。观察组苏醒时和苏醒后30 min，静息时疼痛VAS评分明显低于对照组，差异均有统计学意义（P < 0.05）。观察组患者满意度和麻醉医师满意度评分比较，差异均有统计学意义（P < 0.05）。结论 肥胖患者无痛胃镜和结肠镜检查中应用环泊酚复合艾司氯胺酮，相较于环泊酚复合瑞芬太尼，能进一步维持患者血流动力学稳定，减轻对呼吸和循环的抑制，减少环泊酚用量，提高患者和麻醉医师满意度。值得临床推广应用。

Abstract:

Objective To compare the efficacy and safety of ciprofol combined with esketamine or remifentanil in painless gastroscopy and colonoscopy for obese patients.Methods 126 obese patients due to abdominal pain or loose stools from January to October 2024 and were scheduled to undergo painless gastroscopy combined with colonoscopy were selected and divided into the observation group and the control group by random number table method, with 63 cases in each group. The anesthesia and analgesia regimen for the observation group was ciprofol combined with esketamine, while that for the control group was ciprofol combined with remifentanil. The hemodynamic indicators [heart rate (HR), percutaneous arterial oxygen saturation (SpO₂), and mean arterial pressure (MAP)] of the two groups of patients at different time points [immediately before anesthesia induction (T₀), immediately after the completion of anesthesia induction (T₁), when gastroscopy passed through the laryngeal area (T₂), when colonoscopy passed through the hepatic flexure (T₃), and immediately after the end of the examination (T₄)] were compared. The anesthesia-related conditions (gastroscopy and colonoscopy examination time, anesthesia induction time, anesthesia recovery time and discharge time) of the two groups of patients were compared. The consumption of ciprofol, the use of vasoactive drugs and the occurrence of adverse reactions were compared between the two groups of patients. The visual analogue scale (VAS) scores for pain at the time of awakening and at rest 30 min after awakening were compared between the two groups of patients, as well as the satisfaction scores of patients and anesthesiologists.Results There were statistically significant differences in the time, intergroup and interaction effects of MAP, HR and SpO₂ between the two groups of patients (P < 0.05). The MAP and HR of the observation group at time points T₁, T₂, T₃ and T₄ were significantly higher than those of the control group, and the SpO₂ of the observation group at time points T₁, T₂ and T₃ was significantly higher than that of the control group. The differences were statistically significant (P < 0.05). The MAP at time points T₁, T₂ and T₃ were significantly lower than that at time point T₀, and the HR at the T₃ time point was significantly lower than that at time point T₀ in the observation group. The differences were statistically significant (P < 0.05). In the control group, MAP and HR at time points T₁, T₂, T₃ and T₄ were significantly lower than those at time point T₀, and SpO₂ at time points T₁, T₂ and T₃ were significantly lower than that at time point T₀. The differences were all statistically significant (P < 0.05). There were no statistically significant differences in gastroscopy and colonoscopy examination time, anesthesia induction time, anesthesia recovery time and discharge time between the two groups of patients (P > 0.05). The induction consumption, maintenance consumption, and total consumption in the observation group were significantly less than those in the control groupl, usage rate of vasoactive drugs in the observation group was significantly lower than that in the control group, and the differences were statistically significant (P < 0.05). The incidences of respiratory depression (0.00%), hypotension (1.59%), and bradycardia (0.00%) in the observation group were significantly lower than those in the control group (9.52%, 12.70%, and 11.11%), and the differences were statistically significant (P < 0.05). Comparison of the incidences of airway obstruction, nausea and vomiting, dizziness and headache, injection pain, choking cough, and body movement between the two groups were no statistically significant differences (P > 0.05). The VAS scores of pain at rest in the observation group at awakening and 30 min after awakening were significantly lower than those in the control group, and the differences were statistically significant (P < 0.05). The comparison of the satisfaction scores of patients and anesthesiologists in the observation group showed statistically significant differences (P < 0.05).Conclusion In painless gastroscopy and colonoscopy for obese patients the application of ciprofol combined with esketamine outperforms ciprofol combined with remifentanil in maintaining hemodynamic stability, reducing respiratory depression and circulatory inhibition in patients, decreasing ciprofol dose, and improving patient and anesthesiologist satisfaction. It is a worthy clinical application.