Clinical Application of Esketamine Combined with Propofol in Painless Abortion
-
摘要:
目的 探讨艾司氯胺酮复合丙泊酚在无痛人流术中应用的优势。 方法 选取昆明医科大学第二附属医院行无痛人工流产术的患者50例，随机分为对照组和观察组，每组25例。对照组（F组）：芬太尼复合丙泊酚静脉麻醉；观察组（S组）：艾司氯胺酮复合丙泊酚静脉麻醉。分别记4个时间点的HR、MAP和SpO2；记录2组患者意识消失时间、意识恢复时间、手术时长、丙泊酚使用剂量；记录2组患者术中体动发生率、注射痛发生率、循环抑制和呼吸抑制发生情况、术后不良反应发生率和术后疼痛评分（VAS评分）。 结果 2组患者手术时长、丙泊酚使用剂量、VAS评分、苏醒时间比较，差异无统计学意义（P > 0.05）；在T3时刻，F组患者MAP、HR、SpO2低于S组（P < 0.05）；2组患者注射痛发生率、术后头晕、恶心、呕吐发生率比较，差异无统计学意义（P > 0.05）；S组患者体动、呼吸、循环抑制发生率低于F组（P < 0.05）；S组患者不良反应总发生率低于F组（P < 0.05）。 结论 艾司氯胺酮复合丙泊酚静脉麻醉能够安全有效的运用于无痛人流术，同时能减少术中体动、呼吸和循环抑制、降低术后不良反应的发生率，维持术中血流动力学稳定。 Abstract:Objective To explore the advantages of esketamine combined with propofol in painless abortion. Methods 50 patients who underwent the painless abortion were selected and randomly divided into the control group and the observation group, with 25 in each group. The control group received Fentanyl combined with propofol intravenous anesthesia while the observation group received Esketamine combined with propofol intravenous anesthesia and the HR, MAP and SpO2 before the induction （T1）, immediately after the operation （T2）, 3 min after the operation （T3） and immediately after the operation （T4） was recorded respectively. The time of consciousness loss and recovery, operation duration and dosage of propofol were recorded. The intraoperative body motor reaction, propofol injection pain, circulation depression, respiratory depression, postoperative adverse reactions and postoperative pain were scored （VAS score）. Results The comparison of the operation time, propofol dose, VAS score and recovery time between the two groups proved to be statistically insignificant （P > 0.05）. At T3, MAP, HR, and SpO2 in the control group were lower than those in the observation group （P < 0.05）; The incidence of injection pain, postoperative dizziness, nausea, and vomiting between the two groups proved to be statistically insignificant （P > 0.05）. The incidence of body movement, respiration, and circulation depression in the observation group was lower than that in the control group （P < 0.05）; The overall incidence of adverse reactions in the observation group was lower than that in the control group （P < 0.05）. Conclusion The application of esketamine combined with propofol in TIVA for painless abortion has been proved to be safe and feasible, and can reduce the incidence of intraoperative body motor reaction, respiratory circulation inhibition and other adverse reactions, and maintain the stability of intraoperative hemodynamics. -
Key words:
- Esketamine /
- Propofol /
- Painless abortion /
- Intravenous anesthesia
-
表 1 一般资料比较（
$\bar x \pm s $ ）Table 1. Comparison of the general data （
$\bar x \pm s $ ）组别 年龄（岁） 孕周（周） 体重（kg） F组（n = 25） 29.00 ± 4.16 6.16 ± 1.02 55.24 ± 6.71 S组（n = 25） 27.76 ± 4.81 6.08 ± 0.86 55.92 ± 8.08 t 0.974 0.298 0.323 P 0.335 0.767 0.748 
下载: 导出CSV
表 2 术中情况比较（
$\bar x \pm s $ ）Table 2. Comparison of anesthesia-related indexes and VAS between the two groups （
$\bar x \pm s $ ）组别 丙泊酚总用量（mg） 手术时长（min） 意识消失时间（s） 意识恢复时间（min） VAS评分（分） F组（n = 25） 95.96 ± 12.18 6.80 ± 1.29 38.20 ± 4.97 7.468 ± 1.49 2.44 ± 1.00 S组（n = 25） 91.96 ± 21.09 7.12 ± 2.42 34.80 ± 3.38 7.676 ± 2.36 2.48 ± 0.823 t 0.821 0.583 2.827 0.372 0.154 P 0.416 0.562 0.007* 0.711 0.878 与F组比较，*P < 0.05。
下载: 导出CSV
表 3 不同时刻的MAP比较[（
$\bar x \pm s $ ），mmHg]Table 3. Comparison of MAP at different times between F and S [（
$\bar x \pm s $ ），mmHg]组别 T1 T2 T3 T4 F组（n = 25） 88.92 ± 8.54 83.56 ± 12.02 79.88 ± 9.14 90.44 ± 10.07 S组（n = 25） 90.36 ± 9.34 86.28 ± 9.07 87.12 ± 10.24 89.76 ± 10.03 t 0.568 1.515 2.440 0.745 P 0.572 0.371 0.011* 0.812 与F组比较，*P < 0.05。
下载: 导出CSV
表 4 不同时刻HR比较[（
$\bar x \pm s $ ），次/min]Table 4. Comparison of HR between F and S at different times [（
$\bar x \pm s $ ），times/min]组别 T1 T2 T3 T4 F组（n = 25） 80.44 ± 12.37 73.52 ± 9.54 68.72 ± 9.59 75.44 ± 7.92 S组（n = 25） 79.20 ± 12.47 77.92 ± 10.94 76.20 ± 11.94 77.52 ± 11.50 t 0.353 1.515 2.440 0.745 P 0.726 0.136 0.018* 0.460 与F组比较，*P < 0.05。
下载: 导出CSV
表 5 不同时间点的SpO2比较[（
$\bar x \pm s $ ），%]Table 5. Comparison of SpO2 at different time points between F and S [（
$\bar x \pm s $ ），%]组别 T1 T2 T3 T4 F组（n = 25） 100.00 ± 0.00 98.92 ± 1.5798 99.36 ± 1.41 99.88 ± 0.440 S组（n = 25） 100.00 ± 0.00 99.68 ± 0.98 100.00 ± 0.00 100.00 ± 0.00 t / 2.040 2.628 1.365 P 0.051 0.028* 0.179 与F组比较，*P < 0.05。
下载: 导出CSV
表 6 不良反应发生率比较[n（%）]
Table 6. The incidence of adverse reactions in F andS was compared [n（%）]
组
别丙泊酚注射痛 体动 循环抑制 呼吸抑制 头晕 恶心 呕吐 不良反应总发生率 F组（n = 25） 2
（8.00）14
（56.00）4
（16.00）7
（28.00）8
（32.00）2
（8.00）1
（4.00）19
（76.00）S组（n = 25） 1
（4.00）7
（28.00）0
（0.00）0
（0.00）12
（48.00）2
（8.00）2
（8.00）12
（48.00）χ2 0.355 4.023 4.438 8.149 1.333 0.00 0.355 3.920 P 0.552 0.045* 0.037* 0.004* 0.248 1.00 0.552 0.048* 与F组比较，*P < 0.05。
下载: 导出CSV
-
[1] 付紫辉,王彦松. 人工流产手术的麻醉进展[J]. 医学综述,2019,25(18):3698-3702. doi: 10.3969/j.issn.1006-2084.2019.18.031 [2] 中华医学会麻醉学分会. 《中国麻醉学指南与专家共识》（2017版）[M]. 北京: 人民卫生出版社, 2017: 228-232. [3] Chen J,Zou X,Hu B,et al. Effect of different doses of esketamine compared with fentanyl combined with propofol on hypotension in patients undergoing painless abortion surgery: A prospective,randomized,double-blind controlled clinical trial[J]. BMC Anesthesiology,2022,22(1):1-10. doi: 10.1186/s12871-021-01532-1 [4] 林兴喆,陈启忠,李君,等. 无痛人流术中应用地佐辛与舒芬太尼对患者呼吸功能的影响[J]. 中国妇幼保健,2021,36(13):3040-3042. doi: 10.19829/j.zgfybj.issn.1001-4411.2021.13.037 [5] 唐和敏,李胜林. 不同剂量瑞芬太尼与丙泊酚联合应用于无痛人流的效果观察[J]. 贵州医药,2022,46(1):58-59. doi: 10.3969/j.issn.1000-744X.2022.01.026 [6] VVenkatraman R,Pushparani A,Balaji R,et al. Comparison of low dose intravenous fentanyl and morphine infusion for postoperative analgesia in spine fusion surgeries - a randomized control trial[J]. Brazilian Journal of Anesthesiology (Elsevier),2021,71(4):339-344. [7] 周泓屹,姜帆,曹忠. 地佐辛或芬太尼联合丙泊酚对老年宫腔镜手术患者血流动力学、应激以及认知功能的影响[J]. 兰州大学学报(医学版),2023,49(2):44-49,55. [8] 朱汉兴. 丙泊酚复合芬太尼或舒芬太尼在无痛人流手术中的麻醉效果观察[J]. 中国实用医药,2022,17(3):163-165. [9] 高长胜,黄符香,李永乐. 艾司氯胺酮静注在人工流产术中的应用效果观察[J]. 山东医药,2022,62(11):56-58. doi: 10.3969/j.issn.1002-266X.2022.11.014 [10] 潘建琴. 芬太尼联合丙泊酚用于无痛人流术麻醉的临床观察[J]. 中华全科医学,2015,13(1):45-47,160. doi: 10.16766/j.cnki.issn.1674-4152.2015.01.034 [11] 杨晓旭. 帕瑞昔布钠复合丙泊酚在无痛人流术中的应用[J]. 中国城乡企业卫生,2022,37(6):179-180. doi: 10.16286/j.1003-5052.2022.06.068 [12] 张德应,漆启荣. 氟比洛芬酯注射液在无痛人流术超前镇痛中的应用研究[J]. 现代医学与健康研究电子杂志,2022,6(1):44-46. [13] Shoib S,Kotra M,Javed S,et al. Esketamine-a quick-acting novel antidepressant without the disadvantages of ketamine[J]. Hormone Molecular Biology and Clinical Investigation,2022,43(4):505-511. doi: 10.1515/hmbci-2021-0099 [14] 程英莉,应礼,卢银军. 艾司氯胺酮复合丙泊酚在早期人工流产中的应用[J]. 全科医学临床与教育,2022,20(5):405-409. doi: 10.13558/j.cnki.issn1672-3686.2022.005.007 [15] 钱夏丽,夏凡,沈晓凤,等. 艾司氯胺酮复合丙泊酚在宫腔镜检查术中的应用 doi: 10.12089/jca.2021.07.007J]. 临床麻醉学杂志,2021,37(7):706-708. doi: 10.12089/jca.2021.07.007 [16] 王忠三,何博,刘一成,等. 小剂量盐酸艾斯氯胺酮和异丙酚复合麻醉对无痛人流术的效果观察[J]. 中国现代医药杂志,2022,24(8):52-54. doi: 10.3969/j.issn.1672-9463.2022.08.012 [17] Eberl S,Koers L,Van Hooft J,et al. The effectiveness of a low-dose esketamine versus an alfentanil adjunct to propofol sedation during endoscopic retrograde cholangiopancreatography: A randomised controlled multicentre trial[J]. Eur J Anaesthesiol,2020,37(5):394-401. doi: 10.1097/EJA.0000000000001134 [18] Jonkman K,Van Rijnsoever E,Olofsen E,et al. Esketamine counters opioid-induced respiratory depression[J]. British Journal of Anaesthesia,2018,120(5):1117-1127. doi: 10.1016/j.bja.2018.02.021 -
