艾司氯胺酮对冠状动脉旁路移植手术患者血流动力学及术后谵妄发生率的影响  

Effect of Esketamine on Hemodynamics and Incidence of Postoperative Delirium in Patients Undergoing Coronary Artery Bypass Grafting

作　　者：孙艳斌[1] 王文玺[1] 安海燕[1] 白颖 李亚星 高晓宁 SUN Yanbin;WANG Wenxi;AN Haiyan(Chengde Central Hospital, Hebei Chengde 067000, China)

机构地区：[1]河北省承德市中心医院,河北承德067000 [2]承德医学院,河北承德067000

出　　处：《河北医学》2022年第4期684-689,共6页Hebei Medicine

基　　金：河北省医学科学研究重点课题计划项目,(编号:20181169)。

摘　　要：目的:研究艾司氯胺酮对体外循环下心脏冠状动脉旁路移植手术患者血流动力学及术后谵妄发生率的影响。方法:2019年1月至2021年6月于我院行体外循环(CPB)下心脏冠状动脉旁路移植手术(CABG)患者80例随机分为试验组和对照组,每组40例。入手术室后试验组于麻醉诱导期静注艾司氯胺酮0.5mg/kg。麻醉维持期以0.5mg/kg.h持续静脉泵注,于手术结束时停止输注。对照组输入等量的生理盐水。分别记录入室即刻(T0),气管插管后(T1),切皮时(T2),劈胸骨时(T3),CPB前(T4),CPB停机10min(T5),入ICU即刻(T6)、入ICU6h(T7),入ICU12h(T8)时间点的心率及血压变化;并用经食道超声心动图(TEE)测量T2、T5时刻患者左心室每搏量(SV)、左心室射血分数(LVEF)和心输出量(CO)的变化。并比较患者机械通气时间、住ICU时间、术后镇痛药物用量及苏醒后谵妄发生情况。结果:T1时刻对照组SBP小于T0时刻,差异有统计学意义P<0.05。T5时刻实验组SBP较对照组显著增高;对照组SBP较T0、T2时刻显著降低;差异均有统计学意义P<0.05。T5时刻心率实验组与对照组均较T2时刻增高,差异有统计学意义P<0.05;且T5时刻实验组心率显著高于对照组,差异有统计学意义P<0.05。T6时刻对照组SBP低于T0时刻,差异有统计学意义P<0.05。超声心动图心功能结果显示T5时刻实验组患者LVEF、SV及CO水平显著优于对照组,差异有统计学意义P<0.05。拔除气管导管后12h、24h、72h谵妄发生率两组比较差异无统计学意义P>0.05,实验组不增加术后谵妄发生率。两组机械通气时间及住ICU时间差异有统计学意义P<0.05,试验组短于对照组。术后第一个24h试验组舒芬太尼用量小于对照组,差异有统计学意义P<0.05。结论:体外循环下行CABG患者应用艾司氯胺酮不会增加术后谵妄发生率且可以使患者血流动力学更稳定,并具有降低术后舒芬太尼用量、缩短机械通气时间及住ICU时间、�Objective:To study the effect of esketamine on hemodynamics and postoperative delirium incidence in patients undergoing cardiac coronary artery bypass grafting.Methods:Totally 80 patients undergoing cardiac coronary artery bypass grafting(CABG)under extracorporeal circulation(CPB)in our hospital from January 2019 to June 2021 were randomly divided into a trial group and a control group,with 40 patients in each group.After admission to the operating room,the test group received 0.5mg/kg of esketamine intravenously during the induction period and 0.5mg/kg.h intravenously during the maintenance period,and the infusion was stopped at the end of the operation.In the control group,an equal amount of saline was administered.Heart rate and blood pressure were recorded at the time points of immediate admission(T0),after tracheal intubation(T1),at the time of skin incision(T2),at the time of sternotomy(T3),before CPB(T4),10 min after CPB stop(T5),immediately after admission to ICU(T6),6h after admission to ICU(T7),and 12h after admission to ICU(T8),respectively.The changes of left ventricular stroke volume(SV),left ventricular ejection fraction(LVEF)and cardiac output(CO)were measured by transesophageal echocardiography(TEE)at T2 and T5.The duration of mechanical ventilation,ICU stay,postoperative analgesic drug dosage and occurrence of delirium after awakening were compared.Results:The SBP of the control group at the moment of T1 was smaller than that at the moment of T0,with a statistically significant difference of P<0.05.The SBP of the experimental group at the moment of T5 was significantly higher than that of the control group;the SBP of the control group was significantly lower than that at the moment of T0 and T2;the difference was statistically significant at P<0.05.The heart rate of the experimental group was significantly higher than that of the control group at T5,with a statistically significant difference of P<0.05.The SBP of the control group at T6 was lower than that at T0,with a statistically significant d

关 键 词：冠状动脉旁路移植术 艾司氯胺酮 血流动力学 经食道超声心动图 术后谵妄 

分 类 号：R654.2[医药卫生—外科学]