2023 年第 3 期 第 18 卷

丙泊酚复合小剂量艾司氯胺酮用于老年患者无痛胃肠镜检查的麻醉效果

Anesthetic effect of propofol combined with low dose esketamine on painless gastroenterological endoscopy in elderly patients

作者：赵文度1于洋1马骏1张杰2吴凡3

英文作者：Zhao Wendu1 Yu Yang1 Ma Jun1 Zhang Jie2 Wu Fan3

单位：1首都医科大学附属北京安贞医院麻醉中心，北京100029；2首都医科大学附属北京安贞医院消化内科，北京100029；3首都医科大学三博脑科医院麻醉科，北京100093

英文单位：1Anesthesia Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Gastroenterology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 3Department of Anesthesiology Sanbo Brain Hospital Capital Medical University Beijing 100093 China

关键词：艾司氯胺酮；丙泊酚；无痛胃肠镜检查

英文关键词：Esketamine;Propofol;Painlessgastroenterologicalendoscopy

• 摘要：

• 目的 观察丙泊酚复合小剂量艾司氯胺酮用于老年患者无痛胃肠镜检查的麻醉效果。方法 选择首都医科大学附属北京安贞医院2022年3—9月行无痛胃肠镜检查的老年患者作为研究对象。采用随机数字表法将患者分为观察组和对照组。2组患者接受无痛胃肠镜检查时，观察组缓慢静脉注射艾司氯胺酮注射液0.25 mg/kg，随后缓慢静脉注射丙泊酚2.0～2.5 mg/kg进行麻醉；对照组单纯缓慢静脉注射丙泊酚2.0～2.5 mg/kg进行麻醉。记录并比较2组患者入室后即刻（T0）、进镜前即刻（T1）、内镜至回肠末端（T2）及患者苏醒时（T3）的心率、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）及T1、T2、T3时点的脑电双频指数（BIS）。记录并比较2组的围手术期相关指标、注射痛和不良反应发生情况。结果 本研究共有125例老年患者符合纳入标准，5例患者中途退出，最终有120例患者完成试验，每组60例。T1、T2时点对照组心率、MAP及观察组MAP均低于T0时点，但观察组心率、MAP均高于对照组，差异均有统计学意义（均P<0.05）。观察组麻醉起效时间、丙泊酚追加总量、追加丙泊酚比例、苏醒时间均短于/少于/低于对照组，差异均有统计学意义（均P＜0.05）。观察组丙泊酚注射痛发生率低于对照组［18.3%（11/60）比40.0%（24/60）］，差异有统计学意义（χ2=6.817，P=0.009）。观察组呼吸暂停和低血压的发生率低于对照组［18.3%（11/60）比40.0%（24/60）、23.3%（14/60）比43.3%（26/60）］，差异均有统计学意义（χ2=6.817，P=0.009； χ2=5.400，P=0.020）。结论 老年患者行无痛胃肠镜检查，丙泊酚复合小剂量艾司氯胺酮可以维持更加稳定的血流动力学，减少相关并发症，提供有效的镇静镇痛。

• Objective  To observe the anesthetic effect of propofol combined with low dose esketamine on painless gastroenterological endoscopy in elderly patients. Methods  The elderly patients who underwent painless gastrointestinal endoscopy in Beijing Anzhen Hospital, Capital Medical University from March to September 2022 were selected. Patients were divided into observation group and control group by the random number table method. During painless gastroenterological endoscopy, the observation group was anesthetized by slow intravenous injection of esketamine 0.25 mg/kg and propofol 2.0-2.5 mg/kg; the control group was anesthetized by slow intravenous injection of propofol 2.0-2.5 mg/kg. Heart rate, mean arterial pressure(MAP) and pulse oxygen saturation(SpO2) immediately after entering the room (T0), immediately before endoscopy admission(T1), the lens to the end of ileum(T2) and on awakening(T3), and bispectral index(BIS) at T1, T2 and T3 were recorded and compared between the two groups. The perioperative related indexes, injection pain and adverse reactions of the two groups were recorded and compared. Results  In this study, 125 elderly patients met the inclusion criteria, 5 patients withdrew midway, and finally 120 patients completed the trial, with 60 cases in each group. The heart rate, MAP of the control group and the MAP of the observation group at T1 and T2 were lower than those at T0, while the heart rate and MAP of the observation group were higher than those of the control group(all P<0.05). The onset time of anesthesia, the total amount of additional propofol, the proportion with additional propofol, and the time of awakening of the observation group were shorter/less/lower than those of the control group(all P<0.05). The incidence of propofol injection pain of the observation group was lower than that of the control group ［18.3%(11/60) vs 40.0%(24/60)］（χ2=6.817，P=0.009）. The incidences of apnea and hypotension of the observation group were lower than those of the control group［18.3%(11/60) vs 40.0%(24/60), 23.3%(14/60) vs 43.3%(26/60)］（χ2=6.817，P=0.009; χ2=5.400，P=0.020）. Conclusions  In elderly patients undergoing painless gastroenterological endoscopy, propofol combined with low dose esketamine can maintain stable hemodynamics, reduce related complications, and provide effective sedation and analgesia.