吴磊 万利芹
[摘要] 目的 探讨亚麻醉剂量氯胺酮辅助丙泊酚用于无痛胃肠镜诊疗的安全性及临床麻醉效果。方法 选择我院行胃肠镜诊疗患者80例，ASAⅠ或Ⅱ级。按随機数字表法分为氯胺酮组（KP组）和丙泊酚组（P组），每组40例。观察记录两组患者麻醉诱导前即刻（T0）、入镜前即刻（T1）、内镜到达检查终点时（T2）、内镜退出时（T3）及苏醒时（T4）的SBP、DBP、HR、SpO2；记录诊疗时间、意识消失及苏醒时间、丙泊酚消耗剂量及丙泊酚注射痛发生情况；记录各组患者呛咳、体动、呼吸暂停等不良反应的发生情况。 结果 两组患者T1、T2 时SBP、DBP、HR和SpO2 明显低于T0时（P<0.05 ）； T1、T2 时KP组SBP、DBP、HR和SpO2明显高于P 组（P<0.05）；KP组患者意识消失时间、丙泊酚消耗量、丙泊酚注射痛、呛咳、体动的发生率均显著少于P组（P<0.05）。结论 亚麻醉剂量氯胺酮辅助丙泊酚用于无痛胃肠镜诊疗，能显著减少丙泊酚的用量及注射痛；减少循环波动及呼吸抑制等不良反应发生，麻醉效果优于单独应用丙泊酚。
[关键词] 亚麻醉剂量；氯胺酮；丙泊酚；胃肠镜
[中图分类号] R614 [文献标识码] B [文章编号] 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
胃肠镜诊疗已成为消化道疾病诊疗的重要手段，但内镜对咽部、胃肠道的刺激常引起患者不同程度的痛苦，这使得相当一部分患者须在适当的镇静、镇痛下状态才能完成内镜下操作[1]。丙泊酚为最常用的麻醉药物，单纯丙泊酚或以丙泊酚为主的无痛麻醉方案，可使患者处于无意识状态， 但对呼吸、 循环往往有明显的抑制作用[2]，且丙泊酚镇痛作用弱，不能满足患者无痛的要求，常需与镇痛药复合应用，以减少丙泊酚的用量和减轻不良反应[3，4]。氯胺酮是目前唯一具有镇静作用的静脉麻醉药，亚麻醉剂量氯胺酮是指静脉注射剂量≤0.5 mg/kg[5]，大大降低麻醉剂量氯胺酮副作用的发生率，本研究尝试用亚麻醉剂量氯胺酮辅助丙泊酚与单纯丙泊酚麻醉状态下对患者进行胃肠镜诊疗安全性进行对比观察，现报道如下。
