丙泊酚 氯胺酮：亚麻醉剂量氯胺酮辅佐丙泊酚在无痛胃肠镜治疗中的使用

吴磊　万利芹

[摘要] 意图 讨论亚麻醉剂量氯胺酮辅佐丙泊酚用于无痛胃肠镜治疗的安全性及临床麻醉效果。办法 挑选我院行胃肠镜治疗患者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。调查记载两组患者麻醉诱导前立刻（T0）、入镜前立刻（T1）、内镜抵达查看结尾时（T2）、内镜退出时（T3）及复苏时（T4）的SBP、DBP、HR、SpO2；记载治疗时刻、认识消失及复苏时刻、丙泊酚耗费剂量及丙泊酚打针痛发作状况；记载各组患者呛咳、体动、呼吸暂停等不良反应的发作状况。 成果 两组患者T1、T2 时SBP、DBP、HR和SpO2 显着低于T0时（P<0.05 ）； T1、T2 时KP组SBP、DBP、HR和SpO2显着高于P 组（P<0.05）；KP组患者认识消失时刻、丙泊酚耗费量、丙泊酚打针痛、呛咳、体动的发作率均显着少于P组（P<0.05）。定论 亚麻醉剂量氯胺酮辅佐丙泊酚用于无痛胃肠镜治疗，能显着削减丙泊酚的用量及打针痛；削减循环动摇及呼吸按捺等不良反应发作，麻醉效果优于独自使用丙泊酚。

[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

胃肠镜治疗已成为消化道疾病治疗的重要手法，但内镜对咽部、胃肠道的影响常引起患者不同程度的苦楚，这使得恰当一部分患者须在恰当的冷静、镇痛下状况才干完结内镜下操作[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计划，可使患者处于无认识状况， 但对呼吸、 循环往往有显着的按捺效果[2]，且丙泊酚镇痛效果弱，不能满意患者无痛的要求，常需与镇痛药复合使用，以削减丙泊酚的用量和减轻不良反应[3，4]。氯胺酮是现在仅有具有冷静效果的静脉麻醉药，亚麻醉剂量氯胺酮是指静脉打针剂量≤0.5 mg/kg[5]，大大下降麻醉剂量氯胺酮副效果的发作率，本研讨尝试用亚麻醉剂量氯胺酮辅佐丙泊酚与单纯丙泊酚麻醉状况下对患者进行胃肠镜治疗安全性进行比照调查，现报导如下。