亞麻醉劑量氯胺酮輔助丙泊酚在無(wú)痛胃腸鏡診療中的應(yīng)用

吳磊　萬(wàn)利芹

[摘要] 目的 探討亞麻醉劑量氯胺酮輔助丙泊酚用于無(wú)痛胃腸鏡診療的安全性及臨床麻醉效果。方法 選擇我院行胃腸鏡診療患者80例，ASAⅠ或Ⅱ級(jí)。按隨機(jī)數(shù)字表法分為氯胺酮組（KP組）和丙泊酚組（P組），每組40例。觀察記錄兩組患者麻醉誘導(dǎo)前即刻（T0）、入鏡前即刻（T1）、內(nèi)鏡到達(dá)檢查終點(diǎn)時(shí)（T2）、內(nèi)鏡退出時(shí)（T3）及蘇醒時(shí)（T4）的SBP、DBP、HR、SpO2；記錄診療時(shí)間、意識(shí)消失及蘇醒時(shí)間、丙泊酚消耗劑量及丙泊酚注射痛發(fā)生情況；記錄各組患者嗆咳、體動(dòng)、呼吸暫停等不良反應(yīng)的發(fā)生情況。 結(jié)果 兩組患者T1、T2 時(shí)SBP、DBP、HR和SpO2 明顯低于T0時(shí)（P<0.05 ）； T1、T2 時(shí)KP組SBP、DBP、HR和SpO2明顯高于P 組（P<0.05）；KP組患者意識(shí)消失時(shí)間、丙泊酚消耗量、丙泊酚注射痛、嗆咳、體動(dòng)的發(fā)生率均顯著少于P組（P<0.05）。結(jié)論 亞麻醉劑量氯胺酮輔助丙泊酚用于無(wú)痛胃腸鏡診療，能顯著減少丙泊酚的用量及注射痛；減少循環(huán)波動(dòng)及呼吸抑制等不良反應(yīng)發(fā)生，麻醉效果優(yōu)于單獨(dú)應(yīng)用丙泊酚。

[關(guān)鍵詞] 亞麻醉劑量；氯胺酮；丙泊酚；胃腸鏡

[中圖分類號(hào)] R614 [文獻(xiàn)標(biāo)識(shí)碼] B [文章編號(hào)] 1673-9701（2017）19-0108-03

[Abstract] Objective To investigate the safety and clinical anesthesia effect of propofol assisted with sub-anesthesia doses of ketamine in painless gastrointestinal endoscopy treatment. Methods 80 patients with ASAⅠ or Ⅱ who were given gastrointestinal endoscopy treatment were chosen. The patients were divided into ketamine group（KP group） and propofol group（P group） according to the random number table method， with 40 cases in each group. The SBP，DBP、HR and SpO2 of the two groups were observed and recorded immediately before anesthesia induction（T0）， immediately before underdoing endoscopy（T1），when the endoscope reached the end of the inspection（T2）， when the endoscopy withdrawed （T3） and when awake（T4）.The time of treatment， consciousness loss and awakening time， propofol consumption dose and the occurrence of propofol injection pain were recorded. The incidence of adverse events such as cough， body motion and apnea in each group were recorded. Results The SBP， DBP， HR and SpO2 at T1 and T2 in the two groups were significantly lower in than those at T0（P<0.05）. The SBP， DBP， HR and SpO2 in KP group were significantly higher than those in P group at T1 and T2 （P<0.05）. The incidences of the time of consciousness loss， propofol consumption amount， propofol injection pain， cough and body movement were significantly lower in KP group than in those in P group（P<0.05）. Conclusion Propofol assisted with sub-anesthesia doses of ketamine for the treatment of painless gastrointestinal endoscopy can significantly reduce the amount of propofol and injection pain， and can reduce the occurrence of adverse reactions such as circulatory fluctuations and respiratory depression， and the anesthetic effect of which is better than that of propofol alone.

[Key words] Sub-anesthesia doses； Ketamine； Propofol； Gastrointestinal endoscopy

胃腸鏡診療已成為消化道疾病診療的重要手段，但內(nèi)鏡對(duì)咽部、胃腸道的刺激常引起患者不同程度的痛苦，這使得相當(dāng)一部分患者須在適當(dāng)?shù)逆?zhèn)靜、鎮(zhèn)痛下?tīng)顟B(tài)才能完成內(nèi)鏡下操作[1]。丙泊酚為最常用的麻醉藥物，單純丙泊酚或以丙泊酚為主的無(wú)痛麻醉方案，可使患者處于無(wú)意識(shí)狀態(tài)， 但對(duì)呼吸、 循環(huán)往往有明顯的抑制作用[2]，且丙泊酚鎮(zhèn)痛作用弱，不能滿足患者無(wú)痛的要求，常需與鎮(zhèn)痛藥復(fù)合應(yīng)用，以減少丙泊酚的用量和減輕不良反應(yīng)[3，4]。氯胺酮是目前唯一具有鎮(zhèn)靜作用的靜脈麻醉藥，亞麻醉劑量氯胺酮是指靜脈注射劑量≤0.5 mg/kg[5]，大大降低麻醉劑量氯胺酮副作用的發(fā)生率，本研究嘗試用亞麻醉劑量氯胺酮輔助丙泊酚與單純丙泊酚麻醉狀態(tài)下對(duì)患者進(jìn)行胃腸鏡診療安全性進(jìn)行對(duì)比觀察，現(xiàn)報(bào)道如下。