艾司氯胺酮联合瑞马唑仑在肥胖患者宫腔镜手术的应用

The Application of Esketamine Combined with Remimazolam in Hysteroscopic Surgery of Obese Patients

摘要: 目的：通过比较艾司氯胺酮联合瑞马唑仑与舒芬太尼联合丙泊酚在肥胖患者宫腔镜手术中的麻醉效果，评估肥胖患者使用艾司氯胺酮联合瑞马唑仑的安全性及可行性。方法：选取拟行宫腔镜手术的76例肥胖患者为研究对象，将其完全随机分为实验组(A组)和对照组(C组)。A组采用艾司氯胺酮联合瑞马唑仑复合麻醉，C组采用舒芬太尼联合丙泊酚复合麻醉，比较两组的麻醉效果和安全性。观察并记录各组患者入室时(T1)、麻醉诱导后3 min (T2)、扩张宫颈(T3)及苏醒时(T4)四个时间段的呼吸(PetCO₂, SpO₂, RR)及循环(MAP、HR)的变化情况；记录麻醉相关不良事件的发生率、患者的满意度及麻醉药物输注后的起效时间、检查时间和苏醒时间，并进行比较。结果：两组患者的年龄、身高、体重、BMI等基本资料相比较无统计学差异(P > 0.05)；与C组相比，A组患者的PetCO₂、SPO₂、平均动脉压、心率及呼吸频率的波动均小于对照组，差异有统计学意义(P < 0.05)；A组患者麻醉诱导时间、苏醒时间均短于C组，差异有统计学意义(P < 0.05)；两组患者术中检查时间差异无统计学意义(P > 0.05)；A组患者不良反应发生率低于C组，差异有统计学意义(P < 0.05)，A组患者总满意度高于C组，差异有统计学意义(P < 0.05)。

Abstract: Objective: By comparing the anesthetic effects of the combination of esketamine and remimazolam with those of sufentanil and propofol in obese patients undergoing hysteroscopy, we assessed the safety and feasibility of using esketamine and remimazolam in this patient population. Methods: 76 obese patients undergoing hysteroscopic surgery were selected as the research object and randomly divided into an experimental group (group A) and a control group (group C). Group A was given combined anesthesia with esketamine and remimazolam, while Group C was given combined anesthesia with sufentanil and propofol. The anesthetic effects and safety of the two groups were compared. The respiratory (PetCO₂, SpO₂, RR) and circulatory (MAP, HR) parameters were observed and recorded at four-time points: upon entering the operating room (T1), 3 minutes after anesthesia induction (T2), during cervical dilation (T3), and at the time of emergence from anesthesia (T4). The incidence of anesthesia-related adverse events, patient satisfaction, and the onset time of anesthesia drugs, procedure duration, and emergence time were also recorded and compared among the groups. Results: There was no statistical difference in age, height, weight and BMI between the two groups (P > 0.05). Compared with group C, the fluctuation of PetCO₂, SPO₂, mean arterial pressure, heart rate and respiratory rate in group A was less than that in the control group, and the difference was statistically significant (P < 0.05). The induction time and recovery time of anesthesia in group A were shorter than those in group C, and the difference was statistically significant (P < 0.05). There was no significant difference in the time of intraoperative examination between the two groups (P > 0.05). The incidence of adverse reactions in group A was lower than that in group C (P < 0.05), and the total satisfaction of patients in group A was higher than that in group C (P < 0.05).