摘要
目的:分析艾司氯胺酮麻醉诱导对宫腔镜手术患者血流动力学及应激反应的影响。方法:将2019年10月—2022年9月在我院收治的110例妇科宫腔镜手术患者随机纳入A组、B组,A组55例采用舒芬太尼+丙泊酚进行麻醉诱导,B组采用艾司氯胺酮+丙泊酚进行麻醉诱导,比较两组麻醉相关指标(麻醉起效时间、睁眼时间、定向力恢复时间、术中体动次数、丙泊酚用量)、血流动力学(MAP、HR)、术后疼痛程度(VAS评分)、应激反应指标皮质醇(FC)、心钠素(ANP)、血浆肾上腺素(E)、去甲肾上腺素(NE)、认知功能(MMSE评分)以及不良反应(恶心呕吐、头晕、嗜睡、低血压、呛咳)。结果:B组麻醉起效时间、睁眼时间、定向力恢复时间、术中体动次数、丙泊酚用量(0.69±0.17min、2.76±0.62min、6.59±1.49min、1.36±0.33次、85.49±6.76mg)均少于A组(0.87±0.21min、4.15±1.04min、8.54±2.01min、1.50±0.47次、97.83±8.21mg),麻醉诱导后、宫颈扩张时、术毕时、苏醒时的MAP(96.55±5.38mmHg、94.74±3.82mmHg、96.67±4.09 mmHg、98.15±3.24mmHg)均高于A组(90.63±6.22mmHg、86.14±4.37mmHg、89.65±3.77mmHg、94.85±3.48mmHg),HR(80.12±4.99次/min、87.93±5.57次/min、84.15±3.89次/min、79.75±4.11次/min)低于A组(85.25±5.62次/min、92.54±6.00次/min、95.87±4.33次/min、87.47±5.25次/min),术后2、6、12、24h的VAS评分(1.25±0.27分、2.06±0.32分、2.87±0.83分、2.29±0.76分)低于A组(1.71±0.34分、2.23±0.45分、3.35±1.00分、3.04±0.84分),术后1d的FC、ANP、E、NE水平(12.76±1.60μg/dl、0.29±0.04nmol/L、38.63±4.90ng/L、162.78±45.87ng/L)低于A组(15.36±1.88μg/dl、0.33±0.05nmol/L、45.43±6.31ng/L、180.95±50.62ng/L),术后1d的MMSE评分(26.70±0.85分)高于A组(25.98±0.90分),不良反应发生率(3.8%)低于A组(12.5%)(均P<0.05)。结论:艾司氯胺酮麻醉诱导在宫腔镜手术麻醉中效果较好,可减少患者术中体动次数与丙泊酚用量,稳定血流动力学指标,减轻术后疼痛与应激反应,对认知功能的影响轻微,不良反应少。
Objective:To analyze the effects of anesthesia induction by esketamine during gynecological hysteroscopic surgery of patients on their hemodynamics and stress response.Methods:110 patients who wanted gynecologic hysteroscopic surgeries were included and were randomly divided in group A(55 patients with sufentanil combined with propofol for anesthesia induction)and group B(55 patients with esketamine combined with propofol for anesthesia induction)from October 2019 to September 2022.The values of anesthesia related indicators(onset time of anesthesia,eye opening time,recovery time of orientation,number of body movements during operation,and propofol dosage),the values of hemodynamics indicators(MAP and HR),the postoperative pain score by VAS,the values of stress response indicators(FC,ANP,E,and NE),the MMSE score of cognitive function,and the rates of adverse reactions(nausea and vomiting,dizziness,lethargy,hypotension,and cough)of the patients were compared between the two groups.Results:The anesthetic onset time,the eye opening time,the orientation recovery time,the intraoperative body movement times,and the propofol dosage(0.69±0.17min,2.76±0.62min,6.59±1.49min,1.36±0.33 times,and 85.49±6.76mg)of the patients in group B were significantly lower than those(0.87±0.21min,4.15±1.04min,8.54±2.01min,1.50±0.47 times,and 97.83±8.21mg)of the patients in group A(P<0.05).The MAP values of the patients in group B after anesthesia induction,at the time of cervical dilation,after surgery,and at the time of awakening(96.55±5.38mmHg,94.74±3.82mmHg,96.67±4.09 mmHg,and 98.15±3.24mmHg)were significantly higher than those of the patients in group A(90.63±6.22mmHg,86.14±4.37mmHg,89.65±3.77mmHg,and 94.85±3.48mmHg).The HR values of the patients in group B after anesthesia induction,at the time of cervical dilation,after surgery,and at the time of awakening(80.12±4.99 times/min,87.93±5.57 times/min,84.15±3.89 times/min,and 79.75±4.11 times/min)were significantly lower than those(85.25±5.62 times/min,92.54±6.00 times/min,95.87±4.33 times/min,and 87.47±5.25 times/min)of the patients in group A(P<0.05).The VAS scores(1.25±0.27 points,2.06±0.32 points,2.87±0.83 points,and 2.29±0.76 points)of the patients in group B at 2,6,12 and 24 hours after surgery were significantly lower than those(1.71±0.34 points,2.23±0.45 points,3.35±1.00 points,and 3.04±0.84 points)of the patients in group A(P<0.05).The levels of FC,ANP,E,and NE(12.76±1.60μg/dl,0.29±0.04 nmol/L,38.63±4.90 ng/L,and 162.78±45.87 ng/L)of the patients in group B 1 day after surgery were significantly lower than those(15.36±1.88μg/dl,0.33±0.05 nmol/L,45.43±6.31 ng/L,and 180.95±50.62 ng/L)of the patients in group A(P<0.05).The MMSE score(26.70±0.85 points)of the patients in group B was significantly higher than that(25.98±0.90 points)of the patients in group A(P<0.05).The incidence of adverse reactions(3.8%)of the patients in in group B was significantly lower than 12.5%of the patients in group A(P<0.05).Conclusion:Anesthesia induction by esketamine during gynecological hysteroscopic surgery of the patients has better effect,which can reduce the number of body movements and the amount of propofol used during the surgery,can stabilize the hemodynamic indicators,and can reduce the postoperative pain and stress response of the patients,and with less impacts on the cognitive function and adverse reactions of the patients.
作者
施艳
陈昌城
郑建滨
陈文斌
朱昱
SHI Yan;CHENG Changcheng;ZHENG Jianbin;CHENG Wenbin;ZHU Yu(Ningde Municipal Hospital of Ningde Normal University,Ningde,Fujian Province,352100)
出处
《中国计划生育学杂志》
2023年第7期1596-1601,共6页
Chinese Journal of Family Planning
作者简介
通信作者:陈昌城,511023140@qq.com。
