Guan Yingchao, Wang Haochen, Cong Xiaojing, Zhang Beibei, Lin Yusong, Wang Xiaodong
Department of Anesthesiology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai City, Shandong Province, People's Republic of China.
The Second School of Clinical Medicine of Binzhou Medical University, Yantai City, Shandong Province, People's Republic of China.
Drug Des Devel Ther. 2025 Apr 13;19:2873-2883. doi: 10.2147/DDDT.S515006. eCollection 2025.
We explored whether esketamine anesthesia during first-trimester surgical abortion can reduce intraoperative hemodynamic fluctuations and improve patients' respiratory function.
A total of 197 patients who underwent a first-trimester surgical abortion were included in the analysis. Patients were randomly assigned to either the esketamine anesthesia group (group E, n=98) or sufentanil anesthesia group (group S, n=99). The primary outcomes were systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), heart rate (HR), respiratory rate (RR) and end-tidal carbon dioxide partial pressure (PetCO) during the surgery. Secondary outcomes included body movement, apnea, hypoxemia, postoperative nausea and vomiting (PONV), dizziness, anesthesia recovery time, Richmond Agitation and Sedation Scale (RASS) score, and postoperative pain.
Patients in Group E had a more stable intraoperative SBP (p=0.001), DBP (p=0.014), MBP (p=0.003), and HR (p=0.001). There was no significant difference in intraoperative RR between the two groups (p=0.108); however, PetCO in group E remained at preoperative levels, whereas it increased in group S during surgery (p<0.001). The risk of apnea and hypoxemia in group E was lower (RR 0.32, 95% CI [0.13, 0.76], p=0.006; RR 0.13, 95% CI [0.03, 0.54], p=0.001). The incidence of intraoperative body movement (50% vs 27%, p=0.003), postoperative dizziness (45% vs 30%, p=0.024), and nausea (7% vs 0%, p=0.007) was higher in group E. There were no differences in anesthesia recovery time, postoperative RASS score, pain, or vomiting.
Compared with sufentanil, esketamine anesthesia during the first trimester surgical abortion can maintain stable intraoperative hemodynamics and respiratory function during surgery and reduce apnea and hypoxemia. Esketamine may increase the risk of dizziness and PONV after surgical abortion.
我们探讨了孕早期人工流产术中使用艾司氯胺酮麻醉是否能减少术中血流动力学波动并改善患者呼吸功能。
共有197例行孕早期人工流产术的患者纳入分析。患者被随机分为艾司氯胺酮麻醉组（E组，n = 98）或舒芬太尼麻醉组（S组，n = 99）。主要观察指标为手术期间的收缩压（SBP）、舒张压（DBP）、平均血压（MBP）、心率（HR）、呼吸频率（RR）和呼气末二氧化碳分压（PetCO₂）。次要观察指标包括身体移动、呼吸暂停、低氧血症、术后恶心呕吐（PONV）、头晕、麻醉恢复时间、里士满躁动镇静量表（RASS）评分及术后疼痛。
E组患者术中SBP（p = 0.001）、DBP（p = 0.014）、MBP（p = 0.003）和HR（p = 0.001）更稳定。两组术中RR无显著差异（p = 0.108）；然而，E组PetCO₂维持在术前水平，而S组术中升高（p < 0.001）。E组呼吸暂停和低氧血症风险较低（RR 0.32，95%CI[0.13, 0.76]，p = 0.006；RR 0.13, 95%CI[0.03, 0.54]，p = 0.001）。E组术中身体移动发生率（50%对27%；p = 0.003）、术后头晕发生率（45%对30%；p = 0.024）和恶心发生率（7%对0%；p = 0.007）更高。麻醉恢复时间、术后RASS评分、疼痛或呕吐方面无差异。
与舒芬太尼相比，孕早期人工流产术中使用艾司氯胺酮麻醉可维持术中血流动力学和呼吸功能稳定，并减少呼吸暂停和低氧血症发生。艾司氯胺酮可能增加人工流产术后头晕和PONV的风险。
