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小剂量艾司氯胺酮复合环泊酚在无痛人工流产术中的麻醉效果及对术后负性情绪的影响
Anaesthetic effect of low-dose esketamine compound ciprofol in painless induced abortion and its effect on postoperative negative emotions
收稿日期:  
DOI:10.3969/j.issn.1673-9701.2024.19.013
关键词:  艾司氯胺酮  环泊酚  人工流产术  有效性
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作者单位
朱利君 嘉兴市第二医院内镜中心浙江嘉兴 314000 
朱婷婷 嘉兴市第二医院麻醉科浙江嘉兴 314000 
徐海 嘉兴市第二医院麻醉科浙江嘉兴 314000 
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摘要:目的 探讨小剂量艾司氯胺酮复合环泊酚在无痛人工流产术中的麻醉效果及对术后负性情绪的影响。方法 选取2023年7月至11月于嘉兴市第二医院妇科手术中心行择期无痛人工流产术的100例孕妇为研究对象,根据随机数字表法将其分为对照组和观察组,每组各50例。对照组孕妇静脉注射阿芬太尼10μg/kg和环泊酚0.4mg/kg进行诱导,观察组孕妇静脉注射艾司氯胺酮0.3mg/kg、阿芬太尼10μg/kg及环泊酚0.4mg/kg进行诱导,观察两组孕妇的不良反应发生率及不同时间点心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、经皮动脉血氧饱和度(percutaneous arterial oxygen saturation,SpO2)的变化;观察两组孕妇的环泊酚用量、诱导时间、操作时间、苏醒时间、定向力恢复时间及宫缩痛程度;记录两组孕妇术前1d、术后1d及术后3d的情绪状态。结果 观察组孕妇的低血压、低氧血症、呼吸抑制、体动的发生率均显著低于对照组,环泊酚用量显著少于对照组,诱导时间、苏醒时间及定向力恢复时间均显著短于对照组(P<0.05);T1时,观察组孕妇的HR、MAP、SpO2均显著高于对照组(P<0.05);T2~T3时,观察组孕妇的HR和MAP均显著高于对照组(P<0.05);观察组孕妇苏醒时、苏醒后30min及苏醒后60min的视觉模拟评分法评分均显著低于对照组(P<0.05);观察组孕妇术后1d及3d的焦虑自评量表评分、抑郁自评量表评分均显著低于对照组(P<0.05)。结论 小剂量艾司氯胺酮复合环泊酚可显著降低围手术期不良反应的发生率,同时减轻术后疼痛,维持积极情绪,加快术后康复,是一种安全有效的麻醉策略。
Abstract:Objective To explore the anesthetic effect of low-dose esketamine combined with ciprofol in painless induced abortion and its effect on postoperative negative emotions. Methods A total of 100 pregnant women scheduled for elective painless induced abortion at the Gynecological Surgery Center of the Second Hospital of Jiaxing from July to November 2023 were selected as study subjects. Using the random number table method, they were divided into control group and observation group, with 50 cases in each group. The control group received intravenous injection of 10 μg/kg alfentanil and 0.4 mg/kg ciprofol for induction, while the observation group received intravenous injection of 0.3 mg/kg esketamine, 10 μg/kg alfentanil and 0.4 mg/kg ciprofol for induction. Adverse reaction rates and changes in heart rate (HR), mean arterial pressure (MAP), and percutaneous arterial oxygen saturation (SpO2) at different time points were observed in both groups. Additionally, the consumption of ciprofol, induction time, operation time, awakening time, orientation recovery time, and the degree of uterine contraction pain were evaluated in both groups. The emotional states of the women in both groups were recorded one day before surgery, the first day after surgery, and the third day after surgery. Results The incidence rates of hypotension, hypoxemia, respiratory depression, and body movement in observation group were significantly lower than those in control group, ciprofol consumption in observation group was significantly less than that in control group, and the induction time, awakening time, and orientation recovery time in observation group were significantly shorter than those in control group (P<0.05). At T1, HR, MAP, and SpO2 of observation group were significantly higher than those of control group (P<0.05). From T2 to T3, HR and MAP of observation group were significantly higher than those of control group (P<0.05). The visual analog scale scores at awakening, 30 minutes after awakening, and 60 minutes after awakening in observation group were significantly lower than those in control group (P<0.05). The self-rating anxiety scale and self-rating depression scale scores of observation group on the first and third days after surgery were significantly lower than those of control group (P<0.05). Conclusion Low-dose esketamine combined with ciprofol can significantly reduce the incidence of perioperative adverse reactions, alleviate postoperative pain, maintain a positive emotional state, and accelerate postoperative recovery. It is a safe and effective anesthetic strategy.
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