【罂粟摘要】艾司氯胺酮和阿芬太尼用于宫腔镜检查的比较：一项前瞻性、双盲、随机对照试验

本研究旨在确定艾司氯胺酮与异丙酚联合用于宫腔镜检查的95%有效剂量 (ED95)，然后评估其疗效和安全性。

这项前瞻性、双盲、随机对照试验分成E、A两组。45 名 18-65 岁接受宫腔镜检查的女性被随机分配到 E 组（艾司氯胺酮 + 丙泊酚）或 A 组（阿芬太尼 + 丙泊酚）。采用 Dixon上下法测定艾司氯胺酮和阿芬太尼的 ED95。此外，86 名患者被随机分为 E 组和 A 组，使用计算出的 ED95 剂量的研究药物进行诱导。还记录了使用 ED95% 剂量的麻醉成功率，以及与麻醉诱导、恢复和不良事件相关的参数。

艾司氯胺酮的 ED95 为 0.254 mg/kg（95% CI：0.214-1.004），而阿芬太尼的 ED95 为 9.121 μg/kg（95% CI：8.479-13.364）。 E组麻醉成功率为93.0%，A组麻醉成功率为95.2%（p = 0.664）。复苏后，两组的成功率均达到100%。与 A 组 (67.0 [61.0–79.3] s) 相比，E 组 (60.0 [55.0–70.0] s) 的诱导时间显着缩短 (p = 0.006)。 E 组的呼吸抑制 (p < 0.001)、缺氧 (p = 0.006)、最低围手术期 SpO 2 (p = 0.010) 和低血压 (p = 0.001) 发生率较低。与阿芬太尼相比，艾司氯胺酮对呼吸频率、心率、平均血压和呼气末二氧化碳的影响较小（所有 p < 0.001）。两组术后疼痛无显著差异。

本研究确定了宫腔镜检查期间静脉全身麻醉的艾司氯胺酮 ED 95 剂量。与阿芬太尼相比，艾司氯胺酮显示出较少的呼吸和血流动力学抑制，以及较少的副作用。与阿芬太尼相比，艾司氯胺酮是一种理想的宫腔镜麻醉麻醉剂。

原始文献来源：Weng M,Wang D,Zhong J, et al. Comparison Between Esketamine and Alfentanil for Hysteroscopy: A Prospective, Double-Blind, Randomized Controlled Trial. Drug Des Devel Ther. 2024;18:3629-3641. doi:10.2147/DDDT.S472651

Comparison Between Esketamine and Alfentanil for Hysteroscopy: A Prospective, Double-Blind, Randomized Controlled Trial

Purpose: This study aimed to establish the 95% effective dose (ED95) of esketamine in combination with propofol for hysteroscopy and then to evaluate its efficacy and safety profile.

Patients and Methods: This prospective, double-blind, randomized controlled trial consisted of two cohorts. In cohort 1, 45 women aged 18–65 years undergoing hysteroscopy were randomly assigned to either group E (esketamine + propofol) or group A (alfentanil + propofol). Dixon’s up-and-down method was used to determine the ED95 of esketamine and alfentanil. In cohort 2, 86 patients were randomized to group E and group A, with the calculated ED95 dose of the study drugs used for induction. The success rate of anesthesia using the ED95% dose, along with parameters related to anesthesia induction, recovery, and adverse events were also recorded.

Results: The ED95 of esketamine was 0.254 mg/kg (95% CI: 0.214–1.004), while that of alfentanil was 9.121 μg/kg (95% CI: 8.479–13.364). The anesthesia success rate was 93.0% in group E and 95.2% in group A (p = 0.664). After resuscitation, both groups achieved a 100% success rate. The induction time was significantly shorter in group E (60.0 [55.0–70.0] s) compared to group A (67.0 [61.0–79.3] s) (p = 0.006). Group E had lower rates of respiratory depression (p < 0.001), hypoxia (p = 0.006), minimum perioperative SpO2 (p = 0.010), and hypotension (p = 0.001). Esketamine had less effect on respiratory rate, heart rate, mean blood pressure, and end-tidal carbon dioxide compared to alfentanil (all p < 0.001). There were no significant differences in postoperative pain between the two groups.

Conclusion: This study determined the ED 95 dose of esketamine for intravenous general anesthesia during hysteroscopy. Esketamine showed less respiratory and hemodynamic depression, as well as fewer adverse effects compared to alfentanil. Esketamine is an ideal anesthetic agent compared to alfentanil for hysteroscopic anesthesia.