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Received:December 20, 2025 Published Online:July 30, 2026
Received:December 20, 2025 Published Online:July 30, 2026
中文摘要: 目的 比较不同剂量艾司氯胺酮复合瑞马唑仑在宫腔镜子宫内膜切除术中的应用，以期为优化宫腔镜手术的麻醉管理策略提供依据。方法 选取2024 年12 月至2025 年5 月于芜湖市第一人民医院行宫腔镜子宫内膜切除术的患者108 例，以随机数字表法分为A 组、B 组、C 组，各36 例，分别采用艾司氯胺酮0.2、0.5、0.8 mg/kg复合瑞马唑仑进行麻醉诱导。比较3组术后麻醉恢复时间、围手术期［入室后（T0）、诱导后2 min（T1）、宫颈口扩张时（T2）、术毕（T3）］血流动力学指标、术后疼痛情况，术前及术后2、6、24 h认知功能，以及不良反应情况。结果 C组自主呼吸恢复时间、拔管时间、睁眼时间、定向力恢复时间均长于A组、B组（P<0.05）；A组、C组的MAP、心率波动较大，T1、T2与T0比较差异均有统计学意义（P<0.05）；而B 组的MAP、心率波动小，仅T1轻度降低，且降低幅度小于A 组、C 组（P<0.05），T2、T3与T0水平持平（P>0.05）。T3时A 组、B 组MAP、心率均恢复至T0水平（P>0.05），而C组仍高于T0水平（P<0.05）。术后2、6、12 h视觉模拟量表（VAS）评分A组、B组、C组依次降低（P<0.05）。术后2、6 h C组简易精神状态检查表（MMSE）评分均低于A组、B组（P<0.05）。C组不良反应总发生率高于A组、B组（22.22%，2.78%，2.78%，χ2=10.800，P=0.004）。结论 宫腔镜子宫内膜切除术患者应用0.5 mg/kg 艾司氯胺酮复合瑞马唑仑的血流动力学稳定、麻醉恢复时间短、镇痛作用良好、对术后认知功能的影响小，且安全性高。0.8 mg/kg艾司氯胺酮虽然镇痛效果最强，但在其他方面均差于0.5 mg/kg。
Abstract:Objective To compare the application of different doses of esketamine combined with remimazolam in hysteroscopic endometrial resection，to provide a basis for optimizing the anesthesia management strategy of hysteroscopic surgery. Methods From December 2024 to May 2025，108 patients scheduled for hysteroscopic endometrial resection at the First People's Hospital of Wuhu were selected and randomly divided into group A，group B，and group C using a random number table，with 36 patients in each group. Esketamine was administered at doses of 0.2，0.5，and 0.8 mg/kg，combined with remimazolam，respectively，for anesthesia induction. Anesthesia recovery time，perioperative hemodynamic parameters［after entering the operating room （T0），2 minutes after anesthesia induction（T1），cervical dilation（T2），and at the end of surgery（T3）］，postoperative pain scores，cognitive function preoperatively and at 2，6，and 24 hours postoperatively，and the incidence of adverse events were compared among three groups. Results Patients in group C exhibited significantly longer times to spontaneous breathing recovery，extubation，eye opening，and orientation recovery compared with group A and group B（P<0.05）. The MAP and heart rate in group A and group C fluctuated quite a bit，and there were significant differences at T1，T2 compared to the levels at T0（P<0.05）. In group B，however，the fluctuations in MAP and heart rate were small，with only a slight drop at T1，and the decrease was smaller than in group A and group C（P<0.05），while the rest remained similar to the levels at T0（P>0.05）. At T3，MAP and heart rate in group A and group B returned to T0 levels（P>0.05），while those in group C remained significantly higher than T0 levels（P<0.05）. Postoperative VAS scores at 2，6，and 12 hours decreased sequentially in groups A，B，and C（P<0.05）. At 2 and 6 hours post - surgery，Mini - Mental State Examination（MMSE）scores were significantly lower in group C compared with group A and group B（P<0.05）. Group C had a higher overall incidence of adverse events compared to group A and group B（22.22%，2.78%，2.78%，χ2=10.800，P=0.004）. Conclusion The application of 0.5 mg/kg esketamine combined with remimazolam in patients undergoing hysteroscopic endometrial resection provides stable hemodynamics，short anesthesia recovery time，good analgesic effects，minimal impact on postoperative cognitive function，and high safety. Although 0.8 mg/kg of esketamine has the strongest pain relief effect，it falls short in other aspects compared to 0.5 mg/kg.
keywords: Esketamine Remimazolam Hysteroscopy Hysteroscopic endometrial resection Anesthesia recovery Analgesia Hemodynamics Cognitive function
文章编号： 中图分类号：R614 文献标志码：A
基金项目:安徽省卫生健康科研项目（AHWJ2023A30185）
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