艾司氯胺酮对无痛纤维支气管镜检查患者术后早期恢复质量的影响  

Effect of esketamine on recovery quality in early stage after operation in patients with painless fiberoptic bronchoscopy

作　　者：郭玲玲 何文胜[1] 陈亮[1] 张军[1] 李萍[1] GUO Lingling;HE Wensheng;CHEN Liang;ZHANG Jun;LI Ping(Department of Anesthesiology,Hefei Hospital Affiliated to Anhui Medical University,Hefei,Anhui,230011)

机构地区：[1]安徽医科大学附属合肥医院麻醉科,安徽合肥230011

出　　处：《实用临床医药杂志》2022年第6期90-94,共5页Journal of Clinical Medicine in Practice

基　　金：蚌埠医学院自然科学重点项目(2020byzd312)。

摘　　要：目的探讨艾司氯胺酮联合丙泊酚对无痛纤维支气管镜检查患者术中血流动力学稳定性及术后早期恢复质量的影响。方法选择60例无痛纤维支气管镜检查患者,随机分为艾司氯胺酮组和芬太尼组,每组30例。麻醉诱导时,艾司氯胺酮组静脉缓慢注射艾司氯胺酮0.3 mg/kg及丙泊酚2.5 mg/kg,芬太尼组给予芬太尼1.0μg/kg及丙泊酚2.5 mg/kg。比较2组麻醉诱导前(T_(1))、喉罩置入后(T_(2))、纤维支气管镜进入即刻(T_(3))、镜检结束即刻(T_(4))的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO_(2))及脑电双频指数(BIS)值;术前1 d(T_(0))及术后1 d(T_(5))行恢复质量量表(QoR-40)评分;记录2组丙泊酚用量及不良事件发生情况。结果T_(2)时点,艾司氯胺酮组MAP、HR、SpO_(2)均高于芬太尼组,差异有统计学意义(P<0.05);与T_(1)时点比较,芬太尼组T_(2)时点MAP、HR下降,2组SpO_(2)水平均下降,且芬太尼组下降幅度更大,差异均有统计学意义(P<0.05);与T_(2)时点比较,2组T_(3)时点MAP和HR均升高,芬太尼组SpO_(2)升高,且艾司氯胺酮组T_(3)时点的MAP高于芬太尼组,差异均有统计学意义(P<0.05);2组T_(4)时间的MAP、HR均高于同组T_(3)时点,差异有统计学意义(P<0.05);T_(5)时点,艾司氯胺酮组身体舒适度、情绪状态、心理支持、疼痛评分及总分均高于芬太尼组,差异有统计学意义(P<0.05);艾司氯胺酮组丙泊酚总剂量为(277.67±21.28)mg,少于芬太尼组的(290.33±24.98)mg,差异有统计学意义(P<0.05)。艾司氯胺酮组丙泊酚注射痛及呼吸暂停的发生率低于芬太尼组,差异有统计学意义(P<0.05);2组呛咳及恶心呕吐的发生率比较差异无统计学意义(P>0.05),但艾司氯胺酮组发生例数较少;所有患者均未产生幻觉。结论相较于芬太尼,艾司氯胺酮用于无痛纤维支气管镜检查时患者术中生命体征更加平稳,术后早期恢复质量明显改善,且不良事件发生率更低。Objective To explore the effect of esketamine combined with propofol on hemodynamic stability and recovery quality in the early stage after operation in patients with painless fiberoptic bronchoscopy.Methods A total of 60 patients with painless fiberoptic bronchoscopy were selected and randomly divided into esketamine group and fentanyl group,with 30 cases in each group.During anesthesia induction,the esketamine group was slowly injected with 0.3 mg/kg of esketamine and 2.5 mg/kg of propofol,while the fentanyl group was given fentanyl 1.0μg/kg combined with propofol 2.5 mg/kg.The mean arterial pressure(MAP),heartrate(HR),pulse oxygen saturation(SpO_(2)) and bispectral index(BIS)were compared at time points of before anesthesia induction(T_(1)),after laryngeal mask placement(T_(2)),immediately after fiberoptic bronchoscopy entry(T 3) and immediately after fiberoptic bronchoscopy examination(T_(4)) between two groups;the Quality of Recovery Scale(QoR-40)was performed at 1 day before operation(T_(0)) and 1 day after operation(T_(5));the dosage of propofol and the incidence of adverse events were recorded in both groups.Results At T_(2),the MAP,HR and SpO_(2) in the esketamine group were significantly higher than those in the fentanyl group(P<0.05);compared with T_(1),the MAP and HR decreased significantly at T_(2) in the fentanyl group,SpO_(2) level decreased significantly in both groups,and the decrease range of SpO_(2) was significantly greater in the fentanyl group(P<0.05);compared with T_(2),the MAP and HR at T_(3) in both groups increased significantly,SpO_(2) in the fentanyl group increased significantly,and the MAP at T_(3)in the esketamine group was significantly higher than that in the fentanyl group(P<0.05);the MAP and HR at T_(4) in both groups were significantly higher than those at T_(3) in the same group(P<0.05);at T_(5),scores of the physical comfort,emotional state,psychological support and pain score as well as total score in the esketamine group were significantly higher than those in the fentanyl

关 键 词：艾司氯胺酮 丙泊酚 芬太尼 恢复质量量表 无痛纤维支气管镜 呼吸暂停 

分 类 号：R768.1[医药卫生—耳鼻咽喉科] R614[医药卫生—临床医学]