目的：探讨亚麻醉剂量艾司氯胺酮联合应用丙泊酚对老年无痛肠镜检查患者苏醒质量及促炎因子的影响。方法：选取我院内镜中心预约行无痛结肠镜检查的老年患者200例作为研究对象,按照随机数字表法分为单纯丙泊酚组（对照组）和亚麻醉剂量艾司氯胺酮联合丙泊酚组（观察组）,每组100例。以脑电双频谱指数（BIS）监测麻醉深度。比较两组入室（T0）、进镜前即刻（T1）、镜身过脾曲时（T2）、镜身过肝曲时（T3）、检查结束时（T4）及苏醒时（T5）的心率（HR）、呼吸频率（RR）、平均动脉压（MAP）、血氧饱和度（SpO2）等生命体征及BIS值变化情况;记录两组患者丙泊酚用量、睁眼时间、完成指令动作时间、离开麻醉恢复室（PACU）时间、结肠镜检查时间、恢复质量量表（QoR-40）评分、药物不良反应情况;比较结肠镜检查前后两组患者血清中白介素-1β（IL-1β）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）等促炎性细胞因子水平的差异。结果：T0时,两组患者HR、RR、MAP、SpO2比较均无统计学差异;与T0时比较,T1-T4时两组患者MAP、SpO2降低,HR减慢;T1-T4时,观察组患者MAP、SpO2高于对照组;T0-T5时,两组患者BIS值比较差异均无统计学意义;观察组患者丙泊酚用量明显少于对照组;两组患者睁眼时间、完成指令动作时间、离开PACU时间、结肠镜检查时间比较无统计学差异;T5时,观察组患者在身体舒适度、疼痛、情绪状态、心理支持方面的评分及总分均高于对照组,IL-1β、IL-6、TNF-α水平低于对照组;观察组患者出现低血压、呼吸抑制、体动反应、丙泊酚注射痛等不良反应发生率低于对照组。结论：亚麻醉剂量艾司氯胺酮联合应用丙泊酚可为老年无痛肠镜检查患者提供安全有效的镇静镇痛,能有效降低炎症水平,患者血流动力学稳定,早期苏醒质量高,且不增加呼吸抑制发生率,安全性高。
Abstract
Objective To investigate the effect of subanesthetic dose of esketamine combined with propofol on the recovery quality and pro-inflammatory factors in elderly patients with outpatient colonoscopy. Methods 200 cases of elderly patients with outpatient colonoscopy in our endoscopic center were randomly divided into control group (propofol group) and observation group (subanesthetic dose of esketamine combined with propofol), each were 100 cases. The bispectral index (BIS) was used as an monitoring index of individualized anesthesia depth. The hemodynamic index (HR、RR、MAP、SpO2) and BIS value of two groups were compared at the time of entering the examine-room (T0), immediately before inserting (T1), the colonoscope has passed the splenic flexion (T2), the colonoscope has passed the liver flexion (T3), colonoscopy end-point (T4) and after procedure (T5). The dosage of propofol, eye-opening time, completion time of commanded action, leaving PACU time, colonoscopy time, 40-item questionnaire (QoR-40) score and adverse reactions of two groups were recorded. The pro-inflammatory factors (IL-1β、IL-6, TNF-α) were compared before and after colonoscopy. Results There were no significant difference in HR, RR, MAP and SpO2 between two groups at T0. Compared with T0, MAP, SpO2 and HR of two groups decreased at T1-T4. MAP and SpO2 in observation group were higher than control group at T1-T4. There was no significant difference in BIS value between two groups at T0-T5. The dosage of propofol of observation group was less than control group. The eye-opening time, completion time of commanded action, leaving PACU time and colonoscopy time had no significant difference between two groups. At T5, the QoR-40 score of physical comfort, pain, emotional state, psychological support and total score of observation group were higher than control group, and the level of IL-1β、IL-6, TNF-αof observation group were lower than control group. The incidence of adverse reactions such as hypotension, respiratory depression, somatic reaction and propofol injection pain of observation group were lower than control group. Conclusion Subanesthetic dose of esketamine combined with propofol can provide effective sedation and analgesia for elderly patients with outpatient colonoscopy. The hemodynamics was stable. It can effectively reduce the level of inflammation, improve quality of early awakening with lower respiratory depression.
关键词
亚麻醉剂量 /
艾司氯胺酮 /
结肠镜检查 /
促炎性细胞因子
Key words
subanesthetic dose /
esketamine /
colonoscopy /
pro-inflammatory factors
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参考文献
[1] Sapci I, Guyton K, Church J, et al.Original Research Article Advanced age alone should not preclude surveillance colonoscopy in the octogenarian and older population[J]. Am J Surg, 2022, 223(3): 510-512.
[2] Daly E J, Trivedi M H, Janik A, et al.Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression: a randomized clinical trial[J]. JAMA Psychiatry, 2019, 76(9): 893-903.
[3] Shoib S, Kotra M, Javed S, et al.Esketamine-A quick-acting novel antidepressant without the disadvantages of ketamine[J]. Horm Mol Biol Clin Investig, 2022, 43(4): 505-511.
[4] 王中玉, 李娟, 王安琪, 等. 亚麻醉剂量艾司氯胺酮对行膝关节置换术老年患者麻醉诱导期间血流动力学和应激反应的影响[J]. 中华实用诊断与治疗杂志, 2022, 36(1): 88-92.
[5] Nedel W, Costa R, Mendez G, et al.Negative results for ketamine use in severe acute bronchospasm: a randomised controlled trial[J]. Anaesthesiol Intensive Ther, 2020, 52(3): 215-218.
[6] 郑文婧, 郄晓娟, 郑文芳. GLYX-13 通过 NR2B-ERK-CREB 信号通路改善氯胺酮麻醉后幼鼠认知功能障碍[J]. 中国免疫学杂志, 2020, 36(2): 141.
[7] Wensing A G C L, van Cuilenborg V R, Breel J S, et al. Psychometric evaluation of the Dutch 40-item Quality-of-Recovery scale[J]. Br J Anaesth, 2022, 128(1): e6-e8.
[8] Sneyd J R, Absalom A R, Barends C, et al.Hypotension during propofol sedation for colonoscopy: an exploratory analysis[J]. Br J Anaesth, 2022, 128(4): 610-622.
[9] McIntyre R S, Rosenblat J D, Nemeroff C B, et al. Synthesizing the evidence for ketamine and esketamine in treatment-resistant depression: an international expert opinion on the available evidence and implementation[J]. Am J Psychiatry, 2021, 178(5): 383-399.
[10] Shiroma P R, Thuras P, Wels J, et al.A randomized, double-blind, active placebo-controlled study of efficacy, safety, and durability of repeated vs single subanesthetic ketamine for treatment-resistant depression[J]. Transl Psychiatry, 2020, 10(1): 206.
[11] Grieco S F, Qiao X, Johnston K G, et al.Neuregulin signaling mediates the acute and sustained antidepressant effects of subanesthetic ketamine[J]. Transl Psychiatry, 2021, 11(1): 144.
[12] Zhang C, He J, Shi Q, et al.Subanaesthetic dose of esketamine during induction delays anaesthesia recovery a randomized, double-blind clinical trial[J]. BMC Anesthesiol, 2022, 22(1): 138.
[13] Czyż-Szypenbejl K, Mędrzycka-Dąbrowska W, Kwiecień-Jaguś K, et al.The occurrence of postoperative cognitive dysfunction (POCD) -systematic review[J]. Psychiatr Pol, 2019, 53(1): 145-160.
[14] Wajs E, Aluisio L, Holder R, et al.Esketamine nasal spray plus oral antidepressant in patients with treatment-resistant depression: assessment of long-term safety in a phase 3, open-label study (SUSTAIN-2)[J]. J Clin Psychiatry, 2020, 81(3): 10773.
[15] Gastaldon C, Raschi E, Kane J M, et al.Post-marketing safety concerns with esketamine: a disproportionality analysis of spontaneous reports submitted to the FDA adverse event reporting system[J]. Psychother Psychosom, 2021, 90(1): 41-48.
[16] Barua I, Vinsard D G, Jodal H C, et al.Artificial intelligence for polyp detection during colonoscopy: a systematic review and meta-analysis[J]. Endoscopy, 2021, 53(3): 277-284.
[17] Matoka M, Gajos-Draus A, Majkowska I, et al.P.0078 Inflammatory cytokine plasma levels correlation with MADRS score in patients with treatment-resistant major depression after dry-powder inhaled esketamine administration[J]. European Neuropsychopharmac, 2021, 53: S55-S56.
[18] Wang T, Weng H, Zhou H, et al.Esketamine alleviates postoperative depression-like behavior through anti-inflammatory actions in mouse prefrontal cortex[J]. J Affect Disord, 2022, 307: 97-107.
[19] Barbosa MG, Delfino RS, Sarin LM, et al.Repeated subcutaneous esketamine administration for depressive symptoms and pain relief in a terminally ill cancer patient: a case report[J]. Palliat Med, 2020, 34(6): 822-825.
[20] Tan M, Zhang C, Zeng W, et al.Determining the effective dose of esketamine for mitigating pain during propofol injection by Dixon’s up-and-down method: a double-blind, prospective clinical study of drug dose response[J]. BMC Anesthesiol, 2022, 22(1): 368.
[21] Correia-Melo FS, Leal GC, Vieira F, et al.Efficacy and safety of adjunctive therapy using esketamine or racemic ketamine for adult treatment-resistant depression: A randomized, double-blind, non-inferiority study[J]. J Affect Disord, 2020, 264: 527-534.
基金
株洲市2021年度创新型城市建设专项社会化出资项目（202335）
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