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目的探讨小剂量氯胺酮复合异丙酚靶控镇静用于老年男性患者硬性膀胱镜检查的安全性和有效性。方法45例ASAI～Ⅲ级行硬性膀胱镜检查的老年男性患者,随机分为A组:尿道内灌注2％利多卡因凝胶;B组:尿道内灌注2％利多卡因凝胶+异丙酚靶控镇静;C组:尿道内灌注2％利多卡因凝胶+小剂量氯胺酮+异丙酚靶控镇静。每组15例。记录3组术前、局麻、置镜、检查、术毕时的平均动脉压(MAP)、心率、脉搏血氧饱和度(SPO2),B、C两组警觉／镇静评分(OAA／S)3分时的效应室浓度、苏醒时间,术毕根据视觉模拟评分(VAS)进行疼痛评估。结果A组术中置镜时MAP、心率与术前比较差异有统计学意义(P<0．05);B组术中各时点MAP、心率与术前比较,差异有统计学意义(P<0．05);C组术毕MAP、心率与术前比较,差异有统计学意义(P<0．05)。B、C两组OAA／S评分3分时效应室浓度分别为(1．3±0．2)μg／ml和(1．6±0．2)μg／ml,差异有统计学意义(P<0．05)。B、C两组苏醒时间分别为(3．3±1．2)min和(3．0±0．9)min,差异无统计学意义(P>0．05)。术毕疼痛评估:A组轻度疼痛10例,中度疼痛4例,重度疼痛1例;B、C两组患者均为无痛,并对手术过程无记忆。结论小剂量氯胺酮复合异丙酚靶控镇静用于老年男性患者硬性膀胱镜检查具有良好的镇痛、镇静及顺行性遗忘作用,术中血流动力学稳定,术后苏醒迅速,对老年患者较单独使用异丙酚更加安全、有效。
Objective To investigate the safety and efficacy of target-controlled sedation with low-dose ketamine combined with propofol for rigid cystoscopy in elderly men. Methods Forty-five elderly male patients with ASAI ~ Ⅲ rigid cystoscopy were randomly divided into group A: intraperitoneal infusion of 2% lidocaine gel; group B: intraperitoneal infusion of 2% lidocaine gel plus isopropyl Phenol target controlled sedation; Group C: intraurethral perfusion of lidocaine gel 2% + low dose ketamine + propofol target controlled sedation. 15 cases in each group. The mean arterial pressure (MAP), heart rate, pulse oxygen saturation (SPO2), B / C alertness / sedation score (OAA / S) 3-hour effect room concentration, wake time, surgery based on visual analogue scale (VAS) for pain assessment. Results In group A, MAP and heart rate were significantly different from those before operation (P <0.05). MAP and heart rate at each time point in group B were significantly different from those before operation (P <0.05). The MAP and heart rate of group C were significantly different from those before operation (P <0.05). The OA and S scores of B and C groups were (1.3 ± 0.2) μg / ml and (1.6 ± 0.2) μg / ml, respectively, and the difference was statistically significant (P <0.05). The recovery time of group B and C were (3.3 ± 1.2) min and (3.0 ± 0.9) min, respectively, with no significant difference (P> 0.05). Evaluation of pain at the end of surgery: group A mild pain in 10 cases, 4 cases of moderate pain, severe pain in 1 case; B, C two groups of patients were painless and no memory during surgery. Conclusion Target-controlled sedation with low-dose ketamine combined with propofol has good analgesic, sedative and amnesic obliteration in elderly men with stable hemodynamics and rapid postoperative recovery. In elderly patients It is safer and more effective than using propofol alone.