艾司氯胺酮对全麻俯卧位腰椎手术患者心指数的影响  

Effect of esketamine on cardiac index in patients undergoing prone lumbar surgery under general anesthesia

作　　者：胡平 刘景诗[1] 廖孝芸[1] 孔高茵[1] 邹毅[1] 吕针黎 王路瑶 Hu Ping;Liu Jingshi;Liao Xiaoyun;Kong Gaoyin;Zou Yi;Lyu Zhenli;Wang Luyao(Department of Anesthesiology,Hunan Provincial People′s Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410005,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)麻醉科,长沙410005

出　　处：《中国医师杂志》2022年第4期556-559,565,共5页Journal of Chinese Physician

基　　金：湖南省卫生健康委科研立项课题(202104111006);湖南省围术期加速康复麻醉临床医学研究中心(2018SK7001)。

摘　　要：目的观察艾司氯胺酮对全麻俯卧位腰椎手术患者心指数的影响。方法选取2021年3月至7月湖南省人民医院拟行全麻后俯卧位腰椎手术的患者45例,按随机数字表法分为观察组(24例,A组)和对照组(21例,B组)。A组诱导时静脉给予0.5 mg/kg艾司氯胺酮,俯卧位后静脉持续输注0.15 mg/(kg·h)艾司氯胺酮2 h。B组给予等量生理盐水。两组术中均给予七氟烷、瑞芬太尼维持麻醉,术中间断给予舒芬太尼。记录诱导前(T_(0))、气管插管时(T_(1))、插管后5 min(T_(2))、俯卧位后5 min(T_(3))、俯卧位后10 min(T_(4))、俯卧位后30 min(T_(5))、俯卧位后45 min(T_(6))、俯卧位后60 min(T_(7))、俯卧位后90 min(T_(8))、俯卧位后120 min(T_(9))的平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP)、心指数(CI)、心率(HR);麻醉开始到俯卧位后2 h去甲肾上腺素总用量;术后拔管时间;拔管后15 min、术后6、24 h视觉模拟疼痛评分(VAS)。结果A组T_(3)-T_(9)时的CI与T2时比较差异无统计学意义(均P>0.05),B组T_(3)-T_(7)时的CI与T_(2)时比较明显降低(均P<0.05),B组T_(8)-T_(9)时的CI与T_(2)时比较差异无统计学意义(均P>0.05);A组和B组T_(0)-T_(2)时的CI差异无统计学意义(均P>0.05),A组T_(3)-T_(9)时的CI明显高于B组(均P<0.05);A组去甲肾上腺素用量明显少于B组(P<0.05);两组术中不同时间点的HR、MAP、SBP、DBP比较差异无统计学意义(均P>0.05);两组术后拔管时间差异无统计学意义(P>0.05);两组拔管后15 min、6 h和24 h的VAS评分差异无统计学意义(均P>0.05)。结论术中应用艾司氯胺酮能增加腰椎手术患者俯卧位后CI,减少术中去甲肾上腺素用量。Objective To observe the effect of esketamine on cardiac index in patients undergoing lumbar surgery in prone position under general anesthesia.Methods Forty-five patients with prone lumbar surgery after general anesthesia in Hunan Provincial People′s Hospital from March to July 2021 were divided into observation group(24 cases,group A)and control group(21 cases,group B)according to random number table method.Group A received 0.5 mg/kg esketamine intravenously during induction,and 0.15 mg/(kg·h)esketamine intravenously for 2 h after prone position.Group B received the same amount of normal saline.Both groups were given sevoflurane and remifentanil during operation to maintain anesthesia,and sufentanil was given intermittently during operation.The mean arterial pressure(MAP),systolic blood pressure(SBP),diastolic pressure(DBP),cardiac index(CI),and heart rate(HR)before induction(T_(0)),during endotracheal intubation(T_(1)),5 minutes after intubation(T_(2)),5 minutes after prone position(T_(3)),10 minutes after prone position(T_(4)),30 minutes after prone position(T_(5)),45 minutes after prone position(T_(6)),60 minutes after prone position(T_(7)),90 minutes after prone position(T_(8)),and 120 minutes after prone position(T_(9))were recorded;The total dosage of norepinephrine 2 hours after anesthesia to prone position and extubation time after operation were also recorded.The Visual Analogue Scale(VAS)was performed 15 minutes after extubation,6 and 24 hours after operation.Results There was no significant difference in CI between T_(3)-T_(9) and T2 in group A(P>0.05);the CI of group B at T_(3)-T_(7) was significantly lower than that at T_(2)(all P<0.05);there was no significant difference in CI between T_(8)-T_(9) and T_(2) in group B(all P>0.05);There was no significant difference in CI between group A and group B at T_(0)-T_(2)(all P>0.05).The CI of group A at T_(3)-T_(9) was significantly higher than that of group B(all P<0.05);The dosage of norepinephrine in group A was significantly lower than that in group

关 键 词：腰椎 外科手术 俯卧位 艾司氯胺酮 心指数 

分 类 号：R614[医药卫生—麻醉学]