亚麻醉剂量艾司氯胺酮对行膝关节置换术老年患者麻醉诱导期间血流动力学和应激反应的影响  

Effects of esketamines at subanesthetic dose on hemodynamics and stress response during anesthesia induction in elderly patients undergoing knee arthroplasty

作　　者：王中玉[1] 李娟[1] 王安琪 王朝阳[1] 卫新[1] 邢飞 张卫[1] WANG Zhong-yu;LI Juan;WANG An-qi;WANG Zhao-yang;WEI Xin;XING Fei;ZHANG Wei(Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院麻醉与围术期医学部,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2022年第1期88-92,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省高等学校重点科研项目计划(15A320080)。

摘　　要：目的探讨行膝关节置换术的老年患者应用亚麻醉剂量艾司氯胺酮麻醉诱导期间血流动力学和应激反应的变化。方法择期全身麻醉下行单侧全膝关节置换术老年患者80例,随机分为观察组40例和对照组40例。观察组麻醉诱导依次静脉注射艾司氯胺酮0.2 mg/kg、舒芬太尼0.4~0.5μg/kg、依托咪酯0.2~0.3 mg/kg;对照组麻醉诱导依次静脉注射生理盐水0.2 mg/kg、舒芬太尼0.4~0.5μg/kg、依托咪酯0.2~0.3 mg/kg;2组术中均采用静脉吸入复合麻醉维持。记录麻醉诱导前( T_(0))、气管插管前即刻(T_(1))、气管插管后1 min(T_(2))和5 min(T_(3))、切皮时(T_(4))、切皮后1 min(T_(5))和5 min(T_(6))时心率、收缩压、舒张压、平均动脉压(mean arterial pressure,MAP)、脑电双频指数(bispectral index,BIS);采用ELISA法检测 T_(0)、T_(2)、T_(3)、T_(5)、T_(6)时血浆去甲肾上腺素、肾上腺素水平;记录麻醉诱导期间呛咳、肌阵挛及心血管不良事件发生情况。结果观察组性别比例、年龄、体质量指数、手术时间、合并高血压比率及依托咪酯、舒芬太尼诱导剂量与对照组比较差异均无统学意义(P>0.05)。观察组T_(1)、T_(2)、T_(3)时收缩压[(128.6±13.8)、(136.7±18.9)、(125.2±14.3)mm Hg]、舒张压[(65.2±7.7)、(70.3±8.5)、(63.1±9.5)mm Hg]、MAP[(87.1±8.7)、(92.6±12.2)、(83.7±9.5)mm Hg]、心率[(68.5±7.9)、(75.8±8.4)、(66.2±8.3)次/min]及BIS(49.5±7.9、56.8±8.8、60.8±7.8)均高于对照组[收缩压(111.9±13.4)、(125.6±16.1)、(111.3±13.8)mm Hg,舒张压(59.6±9.0)、(66.1±8.0)、(57.5±6.8)mm Hg,MAP(77.7±10.4)、(86.7±10.0)、(76.2±8.0)mm Hg,心率(60.5±9.4)、(69.3±11.2)、(62.3±7.7)次/min,BIS(45.5±6.2、51.6±9.3、54.3±11.1)](P<0.05), T_(0)、T_(4)、T_(5)、T_(6)时收缩压[(153.0±15.2)、(114.6±19.8)、(125.3±20.6)、(134.3±22.0)mm Hg]、舒张压[(69.7±7.1)、(58.5±10.7)、(64.0±11.9)、(66.9±12.4)mm Hg]、MAP[(99.6±9.5)、(78.5±13.2)、(85.2±15.0)、(90.6±Objective To investigate the changes of hemodynamics and stress response under esketamines anesthesia at subanesthetic dose in elderly patients undergoing total knee arthroplasty.Methods Eighty elderly patients undergoing unilateral total knee arthroplasty under general anesthesia were randomly and equally divided into observation group and control group.Observation group was intravenously injected with 0.2 mg/kg of esketamine,0.4 to 0.5μg/kg of sufentanil and 0.2 to 0.3 mg/kg of etomidate,while control group was intravenously injected with equivalent volume of normal saline,0.4 to 0.5μg/kg of sufentanil and 0.2 to 0.3 mg/kg of etomidate.Both groups were given combined intravenous and inhaled anesthesia during operation.The heart rate,systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP)and bispectral index(BIS)were recorded before induction of anesthesia(T_(0)),just before endotracheal intubation(T_(1)),1 min(T_(2))and 5 min(T_(3))after endotracheal intubation,surgical skin incision(T_(4)),and 1 min(T_(5))and 5 min(T_(6))after surgical skin incision.The concentrations of serum epinephrine(E)and norepinephrine(NE)were determined by ELISA at the time points of T_(0),T_(2),T_(3),T_(5)and T_(6).The incidences of cough,myoclonus and adverse cardiovascular events during induction were recorded.Results There were no significant differences in gender ratio,age,body mass index,operation lasting time,percentage of hypertension and the doses of etomidate and sufentanil between two groups(P>0.05).The SBPs[(128.6±13.8),(136.7±18.9),(125.2±14.3)mm Hg],DBPs[(65.2±7.7),(70.3±8.5),(63.1±9.5)mm Hg],MAPs[(87.1±8.7),(92.6±12.2),(83.7±9.5)mm Hg],heart rates[(68.5±7.9),(75.8±8.4),(66.2±8.3)beats/min],and BIS values(49.5±7.9,56.8±8.8,60.8±7.8)in observation group were higher than those in control group[(111.9±13.4),(125.6±16.1),(111.3±13.8)mm Hg;(59.6±9.0),(66.1±8.0),(57.5±6.8)mm Hg;(77.7±10.4),(86.7±10.0),(76.2±8.0)mm Hg;(60.5±9.4),(69.3±11.2),(62.3±7.7)beats/min;45.5±6.2

关 键 词：膝关节置换术 艾司氯胺酮 老年 血流动力学 应激反应 

分 类 号：R614[医药卫生—麻醉学]