小剂量艾司氯胺酮复合环泊酚在输尿管镜钬激光碎石术中的应用效果

Application effect of low dose esketamine combined with cyclopofol in ureteroscopic holmium laser lithotripsy

摘要:

目的 探讨小剂量艾司氯胺酮复合环泊酚在输尿管镜钬激光碎石术中的应用效果及安全性。方法 选取2021年4月—2023年9月在中国人民解放军联勤保障部队第九〇四医院接受输尿管镜钬激光碎石术治疗的102例患者。按不同麻醉方法分为两组，对照组（50例）采取舒芬太尼复合环泊酚，观察组（52例）采取小剂量艾司氯胺酮复合环泊酚，对比两组麻醉效果。结果 观察组苏醒时间、住院时间、首次进食时间及下床时间均短于对照组（P <0.05）。术后6 h，观察组与对照组视觉模拟评分法（VAS）比较，差异无统计学意义（P >0.05）；术后24 h，观察组VAS评分和警觉/镇静评分（OAA/S）均低于对照组（P <0.05）。观察组与对照组在麻醉前（T₀）、麻醉诱导5 min（T₁）、术毕（T₂）时平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO₂）比较，经重复测量设计的方差分析，结果 ①不同时间点HR、MAP、SpO₂水平比较，差异均有统计学意义（P <0.05）；②观察组与对照组HR、MAP、SpO₂水平比较，差异均有统计学意义（P <0.05），观察组HR、MAP、SpO₂水平波动较稳定，血流动力学平稳较好；③两组HR、MAP、SpO₂水平变化趋势比较，差异均有统计学意义（P <0.05）。观察组术后12、24 h 皮质醇（Cor）、丙二醇（MDA）水平的差值高于对照组（P <0.05），超氧化物歧化酶（SOD）水平的差值低于对照组（P <0.05）。观察组不良反应发生率低于对照组（P <0.05）。结论 对行输尿管镜钬激光碎石术治疗的患者采取小剂量艾司氯胺酮复合环泊酚，可显著减轻应激反应和疼痛，达到更好的镇静效果和更稳定的血流动力学水平。

Abstract:

Objective To analyze the efficacy and safety of low dose esketamine combined with cyclopofol in ureteroscopic holmium laser lithotripsy.Methods Totally 102 patients who received ureteroscopic holmium laser lithotripsy surgery were divided into 2 groups according to different anesthesia methods. The control group (n=50) received sufentanil combined with cyclopofol, and the observation group (n=52) received low-dose esketamine combined with cyclopofol, and the anesthetic effect of the two groups was compared.Results The observation group had shorter awakening time, hospital stay, first feeding time, and time to ambulation than the control group (P <0.05). At 6 h postoperatively, the VAS scores of the observation group and the control group were comparable (P >0.05); at 24 h postoperatively, the VAS scores and the OAA/S scores of the observation group were lower than those of the control group (P <0.05). Compared with the control group, the MAP, HR, and SpO₂ at T₀, T₁, and T₂ in the observation group were all lower (P <0.05). The results showed that: There were significant differences in HR, MAP, and SpO₂ levels at different time points (P <0.05); The HR, MAP, and SpO₂ levels in the observation group were lower than those in the control group (P <0.05), and the fluctuation of HR, MAP, and SpO₂ levels in the observation group was more stable, with better hemodynamics; The trend of changes in HR, MAP, and SpO₂ levels in the two groups was significantly different (P <0.05). The difference in Cor and MDA levels between the observation group and the control group at 12 h and 24 h postoperatively was statistically significant (P <0.05), while the difference in SOD levels was not statistically significant (P >0.05). The incidence of adverse reactions in the observation group was lower than that in the control group (P <0.05).Conclusion Low dose esketamine combined with cyclopofol can significantly reduce stress response and pain, and achieve better sedation and more stable hemodynamic level in patients undergoing ureteroscopic holmium laser lithotripsy surgery.