艾司氯胺酮-丙泊酚靶控输注用于无痛人工流产手术的麻醉效果、安全性及对患者情绪影响评估

Evaluation of anesthetic efficacy, safety, and emotional impact of esketamine-propofol target-controlled infusion for painless induced abortion

摘要:

目的 探讨艾司氯胺酮-丙泊酚靶控输注在无痛人工流产手术中的麻醉效果、安全性及对患者情绪状态的影响。方法 选取2025年6月—2025年11月在梅州市人民医院行无痛人工流产的80例患者，按信封抽签法随机分为艾司氯胺酮组（艾司氯胺酮0.3 mg/kg+丙泊酚3 μg/mL靶控输注）和舒芬太尼组（舒芬太尼0.1 μg/kg+丙泊酚3 μg/mL靶控输注），各40例。比较两组患者不同时间点［T₀（麻醉诱导前，基线）、T₁（手术器械扩张宫颈时）、T₂（宫腔负压吸引刮匙操作时）、T₃（手术结束后5 min）］的血流动力学与呼吸指标、脑电双频指数（BIS）与改良清醒镇静评分（MOAA/S）；记录苏醒时间、清醒时间、术后30 min疼痛评分［视觉模拟评分法（VAS）］；采用焦虑自评量表（SAS）和抑郁自评量表（SDS）评估术前及术后24 h患者情绪状态；观察不良反应发生情况。结果 两组T₀、T₁、T₂、T₃的平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO₂）、BIS、MOAA/S评分比较，结果 ①不同时间点的MAP、SpO₂、BIS、MOAA/S评分比较，差异均有统计学意义（P <0.05）；不同时间点的HR比较，差异无统计学意义（P >0.05）。②两组的MAP、HR、SpO₂、BIS比较，差异均有统计学意义（P <0.05），艾司氯胺酮组MAP、HR、SpO₂、BIS较高；两组的MOAA/S评分比较，差异无统计学意义（P >0.05）。③两组MAP、HR、SpO₂变化趋势比较，差异均有统计学意义（P <0.05）；两组BIS、MOAA/S评分变化趋势比较，差异均无统计学意义（P >0.05）。艾司氯胺酮组苏醒时间、清醒时间和离院时间均短于舒芬太尼组，术后30 min VAS评分高于舒芬太尼组（P <0.05）。两组术前SAS、SDS评分比较，差异均无统计学意义（P >0.05）；艾司氯胺酮组术后24 h SAS、SDS评分均低于舒芬太尼组（P <0.05）；艾司氯胺酮组术前、术后24 h SAS、SDS评分差值均大于舒芬太尼组（P <0.05）。两组术中体动率、头晕率和精神异常率比较，差异均无统计学意义（P >0.05）；艾司氯胺酮组丙泊酚注射痛率、呼吸抑制率、术后恶心呕吐发生率、不良反应总发生率低于舒芬太尼组（P <0.05），流涎发生率高于舒芬太尼组（P <0.05）。结论 艾司氯胺酮-丙泊酚靶控输注用于无痛人工流产，可在维持同等麻醉深度的同时，提供更稳定的术中生命体征、更低的呼吸抑制发生率，并发挥快速抗焦虑抑郁作用。尽管其术后早期镇痛作用弱于舒芬太尼方案，存在一定程度的流涎和精神异常发生率，但其综合应用价值优于传统舒芬太尼方案，是一种具有临床推广价值的优化麻醉策略。

Abstract:

Objective To investigate the anesthetic efficacy, safety, and emotional impact of esketamine-propofol target-controlled infusion in painless induced abortion.Methods Eighty patients who underwent painless induced abortion at Meizhou People's Hospital from June 2025 to November 2025 were selected and randomly divided into an esketamine group and a sufentanil group by envelope drawing, with 40 patients in each group. The esketamine group received esketamine 0.3 mg/kg combined with propofol target-controlled infusion at 3 μg/mL, while the sufentanil group received sufentanil 0.1 μg/kg combined with propofol target-controlled infusion at 3 μg/mL. Hemodynamic and respiratory parameters, bispectral index (BIS), and Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scores were compared between the two groups at different time points: T₀ (before anesthesia induction, baseline), T₁ (during cervical dilation with surgical instruments), T₂ (during intrauterine negative-pressure suction and curettage), and T₃ (5 min after the end of surgery). Recovery time, awakening time, discharge time, and visual analogue scale (VAS) score at 30 min after surgery were recorded. The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate emotional status before surgery and 24 h after surgery. Adverse reactions were also observed.Results There were statistically significant differences in mean arterial pressure (MAP), oxygen saturation (SpO₂), BIS, and MOAA/S scores at T₀, T₁, T₂, and T₃ between the two groups (P < 0.05), whereas no significant difference was observed in heart rate (HR) across different time points (P > 0.05). MAP, HR, SpO₂, and BIS differed significantly between the two groups (P < 0.05), with higher MAP, HR, SpO₂, and BIS values in the esketamine group. No significant difference was found in MOAA/S scores between the two groups (P > 0.05). The trends of MAP, HR, and SpO₂ differed significantly between the two groups (P < 0.05), whereas the trends of BIS and MOAA/S scores showed no significant differences (P > 0.05). Recovery time, awakening time, and discharge time were shorter in the esketamine group than in the sufentanil group, while the VAS score at 30 min after surgery was higher in the esketamine group (P < 0.05). There were no significant differences in preoperative SAS or SDS scores between the two groups (P > 0.05). At 24 h after surgery, SAS and SDS scores were lower in the esketamine group than in the sufentanil group (P < 0.05), and the differences between preoperative and postoperative 24 h SAS and SDS scores were greater in the esketamine group (P < 0.05). There were no significant differences in the incidences of intraoperative body movement, dizziness, or psychiatric symptoms between the two groups (P > 0.05). The incidences of propofol injection pain, respiratory depression, postoperative nausea and vomiting, and overall adverse reactions were lower in the esketamine group than in the sufentanil group (P < 0.05), while the incidence of salivation was higher in the esketamine group (P < 0.05).Conclusion Esketamine-propofol target-controlled infusion for painless induced abortion can maintain a comparable depth of anesthesia while providing more stable intraoperative vital signs, reducing the incidence of respiratory depression, and exerting rapid anxiolytic and antidepressant effects. Although its early postoperative analgesic effect is weaker than that of the sufentanil regimen and it is associated with certain risks of salivation and psychiatric symptoms, its overall clinical value is superior to that of the conventional sufentanil regimen, making it an optimized anesthetic strategy worthy of clinical promotion.