麻醉药物：艾司氯胺酮Vs芬太尼

本文由“小麻哥的日常"授权转载

🇨🇳🏮欢度国庆🏮🇨🇳

🏮摘要译文(供参考)：🏮

不同剂量艾司氯胺酮与芬太尼联合异丙酚对无痛人流手术患者低血压的影响：

一项前瞻性、随机、双盲对照临床试验

🇨🇳背景：🇨🇳

人流手术中常用的阿片类镇痛药与呼吸和循环抑制有关。

艾司氯胺酮是一种N-甲基-D-天冬氨酸受体（NMDA）拮抗剂，也是一种常见的镇痛药。

该药有几个优点，包括起效快、起效快，并且能引起最小的心肺抑制。

然而，研究尚未探讨艾司氯胺酮对无痛人流手术患者的影响。

🇨🇳目的：🇨🇳

本研究旨在评估不同剂量的艾司氯胺酮与芬太尼对无痛人流手术患者围手术期低血压发生率的影响，并探讨该人群的最佳剂量。

🇨🇳方法：🇨🇳

共有178名接受无痛人流手术的女性患者被纳入本研究。

患者年龄为18-45岁，体重指数（BMI）为18-28 kg·m-2，身体状况为一级或二级，由美国麻醉师协会（ASA）标准确定。

患者被随机分为以下四组：

F组（n=45），静脉注射芬太尼1μg · kg-1，然后静脉注射异丙酚2mg· kg-1；

EL组、EM组和EH组（n=45、44、44），分别静脉注射艾司氯胺酮0.2 mg ·kg-1、0.25 mg· kg-1和0.3 mg· kg-1，然后静脉注射2 mg· kg-1异丙酚。

研究的主要结局指标是低血压的发生率，

次要结局指标包括不良事件的发生率、围手术期生命体征的变化、麻醉诱导时间、恢复时间和可出院时间、异丙酚的添加以及患者、外科医生和麻醉师的满意度。

🇨🇳结果：🇨🇳

EL组、EM组和EH组的低血压发生率（0,0,0%）明显低于F组（20%）（χ2=19.648；P=0.000）。

在本研究中，EL组、EM组和EH组受试者的缺氧发生率（0,2.3,2.3%）显著低于F组受试人员（11.1%）（χ2=8.622；P=0.035）。

结果表明，EM组和EH组参与者的躯体运动反应发生率（9.1,4.5%）明显低于F组和EL组患者（26.7,15.6%）（χ2=10.254；P=0.016）。

结果表明，EH组患者恶心呕吐和潜在精神症状的发生率（15.9%，11.4%）明显高于F组（2.20%）、EL组（4.4,0%）和EM组（2.3,2.3%）（χ2=7.493；P=0.038和χ2=8.248；P=0.003）。

在本研究中，EL组、EM组和EH组受试者的平均动脉压（MAP）和心率（HR）与F组患者相比更稳定。

结果表明，EM组患者的出院时间明显短于F组、EL组和EH组患者。

🇨🇳结论：🇨🇳

本研究结果表明，单剂量艾司氯胺酮（0.25 mg · kg-1）可有效降低低血压的发生率和总不良事件，并减少无痛人流患者所需的额外异丙酚剂量的频率，同时保持医患满意度。

🇨🇳关键词：🇨🇳

镇痛；艾司氯胺酮；低血压；阿片类药物；无痛人流；异丙酚。

图1显示研究中使用的实验设计的流程图

图2围手术期生命体征变化

🏮🏮摘要译文🏮🏮

Effect of different doses of esketamine compared with fentanyl combined with propofol on hypotension in patients undergoing painless abortion surgery:

a prospective, randomized, double-blind controlled clinical trial

🇨🇳Background: 🇨🇳

Opioids analgesics commonly used in abortion procedures are associated with respiratory and circulatory depression. Esketamine is a N-methyl-D-aspartate receptor (NMDA) antagonist and a common analgesic. The drug has several advantages including rapid onset and offset and it causes minimal cardiorespiratory depression. However, studies have not explored the effects of esketamine in patients undergoing painless abortion surgery. Therefore, the present study sought to evaluate the effect of different doses of esketamine compared with the effect of fentanyl on incidence of perioperative hypotension in patients undergoing painless abortion surgery and to explore the optimal esketamine dose for this population.

🇨🇳Methods: 🇨🇳

A total of 178 female patients undergoing painless abortion surgery were enrolled to the current study. The patients were aged 18-45 years, had a body mass index (BMI) of 18-28 kg m- 2 and a class I or II physical status as determined using the American Society of Anesthesiologists (ASA) system. Patients were randomly assigned to four groups as follows: group F (n = 45) in which patients underwent intravenous (IV) administration of 1 μg kg- 1 fentanyl followed by IV administration of 2 mg kg- 1 propofol, and group EL, group EM and group EH (n = 45, 44, 44) with patients receiving IV administration of 0.2 mg kg- 1, 0.25 mg kg- 1, 0.3 mg kg- 1 esketamine, respectively, followed by IV administration of 2 mg kg- 1 propofol. The primary outcome of the study was the incidence of hypotension whereas secondary outcomes included incidence of adverse events, perioperative changes of vital signs, anesthesia induction time, recovery time and dischargeable time, propofol addition, as well as patient, surgeon and anesthesiologist satisfaction levels.

🇨🇳Results: 🇨🇳

The findings showed that the incidence of hypotension was significantly lower in subjects in group EL, group EM and group EH (0, 0, 0%) relative to the incidence in patients in group F (20%) (χ2 = 19.648; P = 0.000). In this study, the incidence of hypoxia of subjects in group EL, group EM and group EH (0, 2.3, 2.3%) was significantly lower compared with that of patients in group F (11.1%) (χ2 = 8.622; P = 0.035). The findings indicated that the incidence of somatic motor reactions was significantly lower in participants in group EM and group EH (9.1, 4.5%) relative to that of patients in group F and group EL (26.7, 15.6%) (χ2 = 10.254; P = 0.016). The results showed that the incidence of nausea and vomiting and potential psychiatric symptoms were significantly higher in patients in group EH (15.9, 11.4%) compared with that of participants in group F (2.2, 0%), group EL (4.4, 0%) and group EM (2.3, 2.3%) (χ2 = 7.493; P = 0.038 and χ2 = 8.248; P = 0.003). In this study, the mean arterial pressure (MAP) and heart rate (HR) of subjects in group EL, group EM and group EH were more stable compared with that of patients in group F. Frequency of the additional propofol dose was markedly less in group EM and EH (26.7%, 17,8%) compared with that in group F and EL (9.1, 4.5%) (χ2 = 10.254; P = 0.016). The findings indicated that the dischargeable time was significantly shorter for patients in group EM compared with that of subjects in group F, group EL and group EH.

🇨🇳Conclusions:🇨🇳

The findings of the present study showed that single-dose esketamine (0.25 mg kg- 1) effectively decreased incidence of hypotension and total adverse events and reduced the frequency of additional propofol dose required for patients undergoing painless abortion with preservation of physician-patient satisfaction.

🇨🇳Keywords: 🇨🇳

Analgesia; 

Esketamine; 

Hypotension; 

Opioid; 

Painless abortion; 

Propofol.

Fig. 1 A flow diagram showing the experimental design used in the study

Fig. 2 Perioperative changes of vital signs

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