探讨艾司氯胺酮复合环泊酚应用于人工终止妊娠术的安全性与有效性。

选择2024年1月至3月在民航总医院进行人工终止妊娠术的100例患者为研究对象。采用随机数字表法，将其随机分成研究组(n＝50，采用艾司氯胺酮0.25 mg/kg＋环泊酚0.5 mg/kg进行麻醉)与对照组(n＝50，采用舒芬太尼0.1 μg/kg＋环泊酚0.5 mg/kg进行麻醉) 2组。记录2组患者的一般临床资料、麻醉起效时间及术中情况与相关血流动力学指标[患者进入手术室平静时(T0)、置入扩阴器时(T1)、扩张宫颈时(T2)、手术结束时(T3)、进入恢复室时(T4)的平均动脉压(MAP)与心率]，术后情况、麻醉满意度及麻醉相关不良反应发生率，并采用独立样本t检验或重复测量资料方差分析或χ²检验进行统计学比较。本研究经民航总医院医学伦理委员会审批通过(审批文号：2023-L-K-04)。所有患者充分知情同意，并签署临床研究知情同意书。

①2组患者年龄、身高、体重、手术时停经天数、手术时长等一般临床资料比较，差异均无统计学意义(P>0.05)。②研究组患者麻醉起效时间为(27.7±6.0) s，显著短于对照组的(31.0±5.9) s，并且差异有统计学意义(t＝－3.65，P<0.001)。2组患者术中体动次数、术中追加环泊酚次数与剂量及环泊酚总剂量等分别比较，差异均无统计学意义(P>0.05)。③对2组患者T0~T4的MAP、心率进行重复测量资料方差分析的结果显示，不同处理措施与时间因素存在交互效应，并且差异均有统计学意义(F_{处理×时间}＝3.11、6.17，P_{处理×时间}＝0.015、0.001)，处理措施、时间因素的效应比较，差异均有统计学意义(F_处理＝17.39、11.30，F_时间＝64.97、15.20，均为P<0.001)。进一步分析处理措施的单独效应结果显示，研究组患者T1~T4的MAP和心率，均分别显著高于对照组，并且差异均有统计学意义(P<0.05)。④对2组患者手术结束时清醒程度的改良警觉/镇静量表(MOAA/S)评分及术后恢复室停留时间、恢复室停留期间宫缩痛视觉模拟量表(VAS)评分等分别比较，差异均无统计学意义(P>0.05)。2组患者术后麻醉满意度评分、麻醉相关不良反应发生率分别比较，差异亦均无统计学意义(P>0.05)。

在人工终止妊娠术中，与对患者采取舒芬太尼0.1 μg/kg复合环泊酚的麻醉结果相比，艾司氯胺酮0.25 mg/kg复合环泊酚的麻醉的起效时间更快，镇痛效果相当，术中患者血流动力学更稳定。

To explore the safety and efficacy of esketamine combined with ciprofol in induced abortion.

A total of 100 patients who underwent induced abortion in the Civil Aviation General Hospital from January to March 2024 were selected as the research subjects, and the patients were randomly divided into two groups according to the random number table: study group (n=50, anesthetized with esketamine 0.25 mg/kg + ciprofol 0.5 mg/kg) and control group (n=50, anesthetized with sufentanil 0.1 μg/kg + ciprofol 0.5 mg/kg). The general information, anesthesia onset time, intraoperative medication, related hemodynamic indexes [mean arterial pressure (MAP) and heart rate when the patient was calm upon entering the operating room (T0), when the speculum was inserted (T1), when the cervix was dilated (T2), at the end of the surgery (T3), and upon entering the recovery room (T4)], postoperative conditions, anesthesia satisfaction and occurrence of anesthesia-related adverse reactions were recorded, and statistical comparisons were performed using independent-samples t test, repeated measures ANOVA, or chi-square tests. This study was approved by the Medical Ethics Committee of the Civil Aviation General Hospital (Approval No. 2023-L-K-04). All patients provided fully informed consent and signed the clinical research informed consent form.

①There were no statistically significant differences in general clinical data between two groups of patients, such as age, height, weight, days of amenorrhea, and operation time (P>0.05). ②The onset time of anesthesia in study group was (27.7±6.0) s, which was significantly shorter than that in control group (31.0±5.9) s, and the difference was statistically significant (t=-3.65, P<0.001). There were no significant differences in the number of intraoperative body movements, the number and dosage of intraoperative additional ciprofol, and the total dose of ciprofol (P>0.05). ③Repeated measures ANOVA of MAP and heart rate at time points T0-T4 in the two groups of patients showed that the interaction effects of different treatments and time factors were statistically significant (F_{treatment×time}=3.11, 6.17; P_{treatment×time}=0.015, 0.001), and the effects of treatments and time factors were also statistically significant (F_treatment=17.39, 11.30; F_time=64.97, 15.20; all P<0.001). Further analysis of the individual effects of treatments revealed that MAP and heart rate at time points T1-T4 in study group were significantly higher than those in control group, and the differences were statistically significant (P<0.05). ④There were no significant differences in the modified observer′s assessment of alertness/sedation scale (MOAA/S) score at the end of surgery, postoperative recovery room stay time, and the visual analogue scale (VAS) score of uterine contraction pain during the recovery period between two groups (P>0.05). There were also no statistically significant differences between two groups in anesthesia satisfaction scores and the incidence of anesthesia-related adverse reactions (P>0.05).

In induced abortion, compared with sufentanil 0.1 μg/kg combined with ciprofol, esketamine 0.25 mg/kg combined with ciprofol had a faster onset of anesthesia, comparable analgesic effect, and more stable intraoperative hemodynamics.