艾司氯胺酮在腹腔镜下结直肠癌根治术全身麻醉诱导中的安全性和有效性研究  

Safety and efficacy of esmketamine in induction of general anesthesia for laparoscopic radical resection of colorectal cancer

作　　者：杨茜芳 张晓艳 袁建虎[1] Yang Qianfang;Zhang Xiaoyan;Yuan Jianhu(Department of Anesthesiaology,Beijing Rectum Hospital(Beijing Erlonglu Hospital),Beijing 100120,China)

机构地区：[1]北京市肛肠医院(北京市二龙路医院)麻醉科,100120

出　　处：《北京医学》2021年第10期961-964,969,共5页Beijing Medical Journal

摘　　要：目的探讨艾司氯胺酮在腹腔镜下结直肠癌根治术全身麻醉诱导中的安全性和有效性。方法选取2020年7—12月北京市肛肠医院择期行腹腔镜下结直肠癌根治手术患者60例。采用随机数字表法分为舒芬太尼组(SF组)和艾司氯胺酮组(ES组),每组30例。SF组静脉注射舒芬太尼0.3μg/kg、咪达唑仑0.05 mg/kg、丙泊酚2 mg/kg与维库溴铵0.1 mg/kg行全身麻醉诱导;ES组静脉注射艾司氯胺酮0.5 mg/kg、咪达唑仑0.05 mg/kg、丙泊酚2 mg/kg与维库溴铵0.1 mg/kg行全身麻醉诱导。诱导过程中MAP<70 mmHg(1 mmHg=0.133 kPa)予麻黄碱处理。记录麻醉诱导前(T;)、气管插管前即刻(T;)、插管后即刻(T;)、插管后3 min(T4)、插管后5 min(T;)的SBP、DBP、MAP和HR;记录麻黄碱使用情况;记录两组插管前后脑电双频指数(bispectralindex,BIS)值。两组术中维持均采用靶控输注丙泊酚1.5~2.5μg/ml、持续泵入瑞芬太尼0.1~0.2μg/(kg·min),间断静脉注射维库溴铵0.03mg/kg。记录手术时间、苏醒时间、拔管时间、麻醉恢复室(postanesthesia care unit, PACU)停留时间及不良反应情况。结果与T;时比较,T;时SF组和ES组的SBP[(88.6±6.3)mmHg比(131.3±14.2)mmHg、(111.7±8.2)mmHg比(132.4±22.0)mmHg]、DBP[(56.0±5.5)mmHg比(75.4±7.3)mmHg、(65.5±9.2)mmHg比(74.3±8.1)mmHg]、MAP[(66.3±6.8)mmHg比(93.9±9.4)mmHg、(80.8±9.6)mmHg比(99.8±11.5)mmHg]均明显降低(P<0.05),T;时明显升高[SBP(137.2±12.8)mmHg、(144.7±15.0)mmHg,DBP(87.5±10.1)mmHg、(84.3±11.7)mmHg,MAP(103.9±11.5)mmHg、(106.0±14.0)mmHg,P<0.05],且T;时SF组明显低于ES组(P<0.05);与T;时比较,T;时SF组HR明显降低[(66.1±8.9)bpm比(80.2±10.6)bpm,P<0.05];T;、T4时两组HR均明显升高[SF组(92.0±7.8)bpm、(87.2±9.7)bpm;ES组(88.8±11.9)bpm、(85.0±12.1)bpm,P<0.05],且T;时SF组明显低于ES组(P<0.05);其余时点两组HR差异无统计学意义(P>0.05)。两组插管前后BIS值、手术时间、清醒时间、拔管时间、PACU停留时间差异无统计学Objective To explore the efficacy and safety of esketamine in induction of general anesthesia during laparoscopic surgery for colorectal cancer. Methods A total of 60 patients with elective laparoscopic radical resection of colorectal cancer, were selected from Beijing Rectum Hospital from July to December 2020. Using random number table method, they were divided into sufentanil group(SF group) and esketamine group(ES group), 30 cases in each group. The SF group received intravenous injection of sufentanil 0.3 μg/kg, midazolam 0.05 mg/kg, propofol 2 mg/kg and vecuronium 0.1 mg/kg for general anesthesia induction. ES group received intravenous esketamine 0.5 mg/kg, midazolam 0.05 mg/kg, propofol 2 mg/kg and vecuronium 0.1 mg/kg were induced by general anesthesia. During the induction process, if the MAP was lower than 70 mmHg(1 mmHg=0.133 kpa), the patients were treated with ephedrine. HR, SBP, DBP and MAP were recorded before induction of anesthesia(T;), immediately before tracheal intubation(T;), immediately after tracheal intubation(T;),3 min after tracheal intubation(T;), and 5 min after tracheal intubation(T;). The ephedrine usage, BIS values of the two groups before and after intubation were recorded. Intraoperative maintenance was adopted for both groups: target–controlled infusion of propofol 1.5–2.5 μg/ml, continuous pumping of remifentanil 0.1–0.2 μg/(kg·min). Intermittent intravenous injection of vecuronium bromide 0.03 mg/kg was condacted to maintain anesthesia. The operation time, recovery time, extubation time,PACU stay time and adverse reactions were recorded. Results Compared with T;, SBP [(88.6±6.3) mmHg vs.(131.3±14.2)mmHg,(111.7±8.2) mmHg vs.(132.4±22.0) mmHg], DBP [(56.0±5.5) mmHg vs.(75.4±7.3) mmHg,(65.5±9.2) mmHg vs.(74.3±8.1) mmHg] and MAP [(66.3±6.8) mmHg vs.(93.9±9.4) mmHg,(80.8±9.6) mmHg vs.(99.8±11.5) mmHg] of the two groups were significantly reduced at T;, and significantly increased at T;[SBP(137.2±12.8) mmHg,(144.7±15.0) mmHg, DBP(87.5±10.1) mmHg,(84.3±11.7)

关 键 词：艾司氯胺酮 全身麻醉 麻醉诱导 舒芬太尼 结直肠癌 

分 类 号：R614[医药卫生—麻醉学] R735.34[医药卫生—外科学]