艾司氯胺酮在非气管插管全麻手术中的应用进展

Application Progress of Esketamine in Non-Endotracheal Intubation General Anesthesia Surgery

摘要: 随着无痛舒适化医疗理念的不断推广，全身麻醉已广泛应用于无痛诊疗、围术期舒适管理以及疼痛管理等多个领域，以提升患者的整体医疗体验。非插管全麻手术是一种在全身麻醉下进行，但不需要使用气管插管来维持呼吸道通畅的手术方式，它避免了传统气管插管可能引发的并发症，如喉痉挛、气道损伤及术后咽喉疼痛等，提高了患者的术后舒适度，但非插管全身麻醉也存在可能发生呼吸和循环抑制的局限性，因此寻找到合适的药物和麻醉方案尤为重要。艾司氯胺酮(Esketamine)是由氯胺酮中分离的一种高亲和性的N-甲基-D-天冬氨酸(NMDA)受体非竞争性抑制剂，广泛应用于麻醉诱导与维持、急慢性疼痛管理、精神疾病以及急危重症的治疗等领域。艾司氯胺酮具有强效的镇静和镇痛作用，并且其代谢清除迅速，对呼吸和循环系统的影响较小，是非插管全麻手术的理想麻醉药物选择。然而，由于其可能引发神经精神类不良反应，其临床使用中的剂量与应用策略仍需进一步探讨和研究。基于上述背景，本文综述了艾司氯胺酮的药理学特性，并对其在非插管全身麻醉手术中的优势与局限性进行了深入分析，以期为临床实践提供参考。

Abstract: With the continuous promotion of the concept of painless and comfortable medical treatment, general anesthesia has been widely used in many fields such as painless diagnosis and treatment, perioperative comfort management and pain management to improve the overall medical experience of patients. Non-intubated general anesthesia surgery is a surgical method that is performed under general anesthesia, but does not require the use of tracheal intubation to maintain airway patency. It avoids complications that may be caused by traditional tracheal intubation, such as laryngospasm, airway injury and postoperative sore throat, and improves the postoperative comfort of patients. However, non-intubated general anesthesia also has the limitation of respiratory and circulatory depression, so it is particularly important to find the appropriate drug and anesthesia program. Esketamine is a high-affinity non-competitive inhibitor of N-methyl-D-aspartate (NMDA) receptor isolated from ketamine, which is widely used in the fields of anesthesia induction and maintenance, acute and chronic pain management, mental diseases, and treatment of acute and severe diseases. Esketamine has a strong sedative and analgesic effect, and its metabolic clearance is rapid, with little effect on the respiratory and circulatory systems, which is an ideal anesthetic drug choice for non-intubation general anesthesia surgery. However, since it may cause neuropsychiatric adverse reactions, its dosage and application strategy in clinical use still need to be further explored and studied. Based on the above background, this article reviews the pharmacological characteristics of esketamine, and analyzes its advantages and limitations in non-intubated general anesthesia surgery, in order to provide reference for clinical practice.