右美托咪定、丙泊酚联合小剂量艾司氯胺酮在宫腔镜手术中的临床应用

doi:10.3760/cma.j.issn.1007-1245.2022.15.005

国际医药卫生导报 ›› 2022, Vol. 28 ›› Issue (15): 2093-2097.DOI: 10.3760/cma.j.issn.1007-1245.2022.15.005

右美托咪定、丙泊酚联合小剂量艾司氯胺酮在宫腔镜手术中的临床应用

都淑萍¹ 王晓东¹ 潘红霞¹ 孟庆伟¹ 王卫卫¹ 于松杨¹ 王志娟²

¹威海市立医院麻醉科，威海　264200； ²南方医科大学珠江医院《中华神经医学杂志》编辑部，广州　510282

收稿日期:2022-04-28 出版日期:2022-08-01 发布日期:2022-08-01
通讯作者: 王志娟，Email：574516185@qq.com
基金资助:
山东省医学会舒适化医疗科研基金（YXH2020ZX017）；

广东省科技计划项目（2017A030303020）

Clinical effect of dexmedetomidine and propofol combined with a low dose of esketamine in hysteroscopy

Du Shuping¹, Wang Xiaodong¹, Pan Hongxia¹, Meng Qingwei¹, Wang Weiwei¹, Yu Songyang¹, Wang Zhijuan²

¹Weihai Municipal Hospital, Weihai 264200, China; ²Editorial Department of Chinese Journal of Neuromedicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China

Received:2022-04-28 Online:2022-08-01 Published:2022-08-01
Contact: Wang Zhijuan, Email: 574516185@qq.com
Supported by:
Scientific Research Fund for Comfortable Medical Treatment of Shandong Medical Association (YXH2020ZX017);

Project of Plan of Science and Technology in Guangdong (2017A030303020)

摘要/Abstract

摘要： 目的　探讨右美托咪定、丙泊酚联合小剂量艾司氯胺酮在宫腔镜手术中的临床应用效果。方法　选择2021年1月至12月在威海市立医院接受妇科宫腔镜手术的96例女性患者，年龄18～60岁，按随机数字表法将其分为对照组（48例）和研究组（48例）。对照组采取右美托咪定联合丙泊酚全凭静脉麻醉，研究组采取右美托咪定、丙泊酚联合小剂量艾司氯胺酮全凭静脉麻醉。观察并记录入室（T0）、Ramsay评分达到5分时（T1）、扩宫颈时（T2）、苏醒时（T3）的平均动脉压（MAP）、心率（HR）和脉搏氧饱和度（SpO₂），记录术中丙泊酚的用量、术后苏醒时间以及围术期不良反应的发生情况。采用独立样本t检验、重复测量的方差分析、χ²检验。结果　研究组T1时MAP、HR和SpO₂明显高于对照组［（68.5±8.9）mmHg比（59.3±7.5）mmHg（1 mmHg=0.133 kPa）、（75.3±6.4）次/min比（60.5±7.7）次/min、（98.5±0.6）%比（95.5±1.1）%，均P<0.05］；T2时MAP和HR低于对照组［（73.8±10.1）mmHg比（83.5±11.8）mmHg、（76.1±9.7）次/min比（89.7±8.7）次/min，均P<0.05］；对照组术中丙泊酚的用量大于研究组［（269.2±29.2）mg比（216.7±25.2）mg，t=9.430，P<0.001］；苏醒时间明显长于研究组［（6.9±1.3）min比（5.5±1.2）min，t=5.482，P<0.001］；术中对照组体动反应、呼吸抑制发生率均高于研究组［25.0%（12/48）比4.2%（2/48）、31.2%（15/48）比6.2%（3/48），均P<0.05］；两组术后恶心、呕吐、眩晕的发生率差异均无统计学意义（均P>0.05）。结论　右美托咪定、丙泊酚联合小剂量艾司氯胺酮用于妇科宫腔镜手术麻醉，术中循环呼吸平稳，术后苏醒快，可控性好，不良反应发生率低，具有较高的临床应用价值。

关键词: 艾司氯胺酮, 右美托咪定, 丙泊酚, 宫腔镜手术

Abstract: Objective　To investigate clinical effect of dexmedetomidine, propofol, and a low dose of esmketamine in hysteroscopy. Methods　Niety-six female patients who were 18-60 years old and underwent gynecological hysteroscopic surgery in Weihai Municipal Hospital from January to December 2021 were selected, were divided into a control group (48 cases) and a study group (48 cases) by the random number table method. The control group was anesthetized with dexmedetomidine and propofol, and the study group with dexmedetomidine, propofol, and a low dose of esmketamine. The mean arterial pressures (MAP), heart rates (HR), and pulse oxygen saturations (SpO₂) when entering the room (T0), when the Ramsay score reached 5 (T1), at cervical dilation (T2), and when they woke up (T4) were observed and recorded. The dosages of propofol during operation, the recovery times after operation, and the occurrences of perioperative adverse reactions were recorded. The independent-sample t test, repeated measure ANOVA, and χ² test were applied. Results　At T1, the MAP, HR, and SpO₂ in the study group were obviously higher than those in the control group [(68.5±8.9) mmHg (1 mmHg=0.133 kPa) vs. (59.3±7.5) mmHg, (75.3±6.4) beats/min vs. (60.5±7.7) beats/min, and (98.5±0.6)% vs. (95.5±1.1)%; all P<0.05]; at T2, the MAP and HR in the study group were lower than those in the control group [(73.8±10.1) mmHg vs. (83.5±11.8) mmHg and (76.1±9.7) beats/min vs. (89.7±8.7) beats/min; both P<0.05]. The dosage of propofol in the control group was greater than that in the study group [(269.2±29.2) mg vs. (216.7±25.2) mg; t=9.430, P<0.001]. The recovery time in the control group was significantly longer than that in the study group [(6.9±1.3) min vs. (5.5±1.2) min; t=5.482, P<0.001]. The incidences of locomotor response and respiratory depression in the control group were significantly higher than those in the study group [25.0% (12/48) vs. 4.2% (2/48) and 31.2% (15/48) vs. 6.2% (3/48); both P<0.05]. There were no statistical differences in the incidences of postoperative nausea and vomiting and vertigo between the two groups (both P>0.05). Conclusion　The use of dexmedetomidine, propofol, and a low dose of esmketamine in gynecological hysteroscopic anesthesia has smooth circulation and breathing, rapid postoperative recovery, good controllability, and a low incidence of adverse reactions, with high clinical application value.

Key words: Esketamine, Dexmedetomidine, Propofol, Hysteroscopy

都淑萍　王晓东　潘红霞　孟庆伟　王卫卫　于松杨　王志娟. 右美托咪定、丙泊酚联合小剂量艾司氯胺酮在宫腔镜手术中的临床应用[J]. 国际医药卫生导报, 2022, 28(15): 2093-2097.

Du Shuping, Wang Xiaodong, Pan Hongxia, Meng Qingwei, Wang Weiwei, Yu Songyang, Wang Zhijuan. Clinical effect of dexmedetomidine and propofol combined with a low dose of esketamine in hysteroscopy[J]. International Medicine and Health Guidance News, 2022, 28(15): 2093-2097.

参考文献

[1] Gould D, Kelly D, Goldstone L, et al. Examining the validity of pressure ulcer risk assessment scales: developing and using illustrated patient simulations to collect the data[J]. J Clin Nurs, 2001,10(5):697-706. DOI: 10.1046/j.1365-2702.2001.00525.x.
[2] 王虹,宋铁鹰,王春平,等.右美托咪啶辅助异丙酚靶控在官腔镜黏膜下肌瘤电切术的有效性及安全性研究[J].河北医药,2012,34(4):517-518.DOI:10.3969/j.issn.1002-7386. 2012.04.017.
[3] 韩明杰,陈振毅.地佐辛复合瑞芬与丙泊酚用于宫腔镜电切术静脉麻醉的临床观察[J].国际医药卫生导报,2018,24(8):1233-1236.DOI:10.3760/cma.j.issn.1007-1245.2018. 08.033.
[4] Eberl S, Koers L, van Hooft JE, et al. Sedation with propofol during ERCP: is the combination with esketamine more effective and safer than with alfentanil?[J] Study protocol for a randomized controlled trial, Trials, 2017,18(1):472. DOI: 10.1186/s13063-017- 2197-8.
[5] 米军桥,江岩,王世端,等.右美托咪定-氯胺酮静脉复合麻醉在宫颈锥切术中的临床应用[J].中国新药与临床杂志,2019,38(1):33-37.DOI:10.14109/j.cnki.xyylc.2019. 01.007.
[6] 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[J].临床麻醉学杂志,2021,37(7):706-708.DOI:10.12089/jca.2021.07.007.
[7] 王晓东,于明涛,刘子强,等.苯磺酸瑞马唑仑联合艾司氯胺酮静脉麻醉在内镜下逆行胰胆管造影术中的临床应用[J].中国医刊,2021,56(3):274-277.DOI:10.3969/j.issn. 1008-1070.2021.03.012.
[8] Bingol Tanriverdi T, Koceroglu I, Devrim S, et al. Comparison of sedation with dexmedetomidine vs propofol during hysteroscopic surgery: single-centre randomized controlled trial[J]. J Clin Pharm Ther, 2019,44(2):312-317. DOI: 10.1111/jcpt.12793.
[9] Qiu G, Wu Y, Yang Z, et al. Dexmedetomidine activation of dopamine neurons in the ventral tegmental area attenuates the depth of sedation in mice[J]. Anesthesiology, 2020,133(2):377-392. DOI: 10.1097/ALN. 0000000000003347.
[10] Lin YS, Liu KD, Chang C, et al. Inhibitory concentration of propofol in combination with dexmedetomidine during microelectrode recording for deep brain stimulator insertion surgeries under general anesthesia[J]. J Chin Med Assoc, 2020,83(2):188-193. DOI: 10.1097/JCMA.0000000000000248.
[11] Kaur G, Kaur P, Gupta R, et al. Discharge readiness after minor gynaecological surgeries comparing dexmedetomidine and ketamine premedication in bispectral index (BIS) guided propofol-based anaesthesia[J]. Indian J Anaesth, 2021,65 Suppl 1:S34-S40. DOI: 10.4103/ija.IJA_998_20.
[12] 米军桥,蔡胜男,王世端.右美托咪定与氯胺酮复合用药的临床应用进展[J].中国新药与临床杂志,2021,40(7):488-493.DOI:10.14109/j.cnki.xyylc.2021.07.02.
[13] Lee C, Jones TA. Effects of ketamine compared with urethane anesthesia on vestibular sensory evoked potentials and systemic physiology in mice[J]. J Am Assoc Lab Anim Sci, 2018,57(3):268-277. DOI: 10.30802/AALAS-JAALAS-17-000131.
[14] El Sharkawy RA. Efficacy of adding low-dose ketamine to dexmedetomidine versus low-dose ketamine and propofol for conscious sedation in patients undergoing awake fiber-optic intubation[J]. Anesth Essays Res, 2019,13(1):73-78. DOI: 10.4103/aer.AER_181_18.
[15] Patel J, Thosani R, Kothari J, et al. Clonidine and ketamine for stable hemodynamics in off-pump coronary artery bypass[J]. Asian Cardiovasc Thorac Ann, 2016,24(7):638-646. DOI: 10.1177/0218492316663359.
[16] Zeballos JL, Lirk P, Rathmell JP. Low-Dose ketamine for acute pain management: a timely nudge toward multimodal analgesia[J]. Reg Anesth Pain Med, 2018,43(5):453-455. DOI: 10.1097/AAP.0000000000000810.
[17] Riddell JM, Trummel JM, Onakpoya IJ. Low-dose ketamine in painful orthopaedic surgery: a systematic review and meta-analysis[J]. Br J Anaesth, 2019,123(3):325-334. DOI: 10.1016/j.bja.2019.05.043.

右美托咪定、丙泊酚联合小剂量艾司氯胺酮在宫腔镜手术中的临床应用

Clinical effect of dexmedetomidine and propofol combined with a low dose of esketamine in hysteroscopy

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 3

编辑推荐

Metrics

[1]	赵贞贞. 盐酸右美托咪定在颅内动脉瘤介入治疗中的麻醉效果 [J]. 国际医药卫生导报, 2022, 28(6): 765-768.
[2]	张广琦葛俊峰. 丙泊酚联合去氧肾上腺素诱导在眼科全麻手术中对血流动力学的影响[J]. 国际医药卫生导报, 2022, 28(16): 2339-2342.
[3]	杨世杰刘树杰曹芮闫玉荣. 艾司氯胺酮在剖宫产中的应用及研究进展[J]. 国际医药卫生导报, 2022, 28(13): 1919-1922.