最低剂量艾司氯胺酮联合右美托咪定对全麻术后患者复苏效果和咽喉痛的影响  

Effect of minimum dose of Esketamine combined with Dexmedetomidine on resuscitation and sore throat after general anesthesia

作　　者：靳永强[1] 张妮妮 周文凤 张雷[1] 郭林 唐靖 JIN Yongqiang;ZHANG Nini;ZHOU Wenfeng;ZHANG Lei;GUO Lin;TANG Jing(Department of Anesthesiology,Guangzhou Key Laboratory of Enhanced Recovery after Abdominal Surgery,the Fifth Affiliated Hospital of Guangzhou Medical University,Guangdong Province,Guangzhou510700,China)

机构地区：[1]广州医科大学附属第五医院麻醉科,广州市加快康复腹部外科重点实验室,广东广州510700

出　　处：《中国当代医药》2022年第10期5-9,共5页China Modern Medicine

基　　金：广东省医院药学研究基金(新晨舒适化医疗专项基金)(2020XC09);广东省广州市卫生健康科技项目(20201A010069)。

摘　　要：目的探讨最低剂量艾司氯胺酮联合右美托咪定持续静脉泵注对全麻气管插管术后患者的复苏质量以及咽喉痛的影响。方法选取2020年10月至2021年6月广州医科大学附属第五医院麻醉科择期行气管插管术后90例患者作为研究对象,按照随机数字表法分为对照组(n=45)和观察组(n=45)。对照组术后静脉持续泵注瑞芬太尼和右美托咪定,观察组术后静脉持续泵注最低剂量艾司氯胺酮和右美托咪定。比较两组患者的苏醒时间、拔管时间;观察两组患者在给药前(T_(0)),拔管时(T_(1)),给药后0.5 h(T_(2))、1 h(T_(3))时的循环指标变化;比较两组患者清醒后的Ricker镇静-躁动评分(SAS);统计两组患者复苏期的相关并发症;评估两组患者离室时、术后6 h伤口视觉模拟量表(VAS)评分和术后12 h咽喉痛VAS评分。结果两组患者苏醒时间和拔管时间比较,差异无统计学意义(P>0.05)。观察组T_(2)、T_(3)时的HR高于对照组,差异有统计学意义(P<0.05),两组各时间点的MAP比较,差异无统计学意义(P>0.05)。两组患者清醒后SAS评分比较,差异无统计学意义(P>0.05)。两组患者均未发生复苏期药物相关并发症。两组患者在离室时、术后6 h伤口VAS评分比较,差异无统计学意义(P>0.05),但观察组术后12 h咽喉痛VAS评分低于对照组,差异有统计学意义(P<0.05)。结论最低剂量艾司氯胺酮联合右美托咪定静脉注射对患者复苏时间和拔管时间无明显影响,循环稳定,安全性较高,可有效抑制术后伤口痛和咽喉痛。在麻醉复苏期该给药方案可作为阿片类药物的替代值得临床借鉴。Objective To explore the effect of minimum dose of Esketamine combined with Dexmedetomidine on resuscitation and sore throat after general anesthesia.Methods A total of 90 patients who underwent elective endotracheal intubation in the Department of Anesthesiology,the Fifth Affiliated Hospital of Guangzhou Medical University from October 2020 to June 2021 were selected as the research subjects,and were divided into control group(n=45)and observation group(n=45)according to random number table method.The control group was continuously pumped with Remifentanil and Dexmedetomidine,while the observation group was continuously pumped with the lowest dose of Esketamine and Dexmedetomidine.The recovery time and extubation time were compared between the two groups.The changes of circulatory indexes in two groups were observed before administration(T_(0)),at extubation(T_(1)),and at 0.5 h(T_(2))and 1 h(T_(3))after administration.Ricker sedative-agitation score(SAS)was compared between the two groups after awakening.The related complications in the resuscitation period of patients in the two groups were analyzed.The visual analogue scale(VAS)score of wound at exit,6 h after surgery and the VAS score of sore throat at 12 h after surgery were evaluated.Results There were no significant differences in the recovery time and extubation time between two groups(P>0.05).The HR of observation group at T_(2) and T_(3) were higher than those of control group,the differences were statistically significant(P<0.05).There was no significant difference in MAP between the two groups at each time point(P>0.05).There was no significant difference in SAS score between two groups after awakening(P>0.05).There were no drug-related complications in the recovery period in both groups.There was no significant difference in VAS score between the two groups at exit and 6 h after surgery (P>0.05). While the sore throat VAS score at 12 h after operation in the observation group was lower than that in the control group, the difference was statistically

关 键 词：艾司氯胺酮 右美托咪定 复苏质量 术后咽喉痛 

分 类 号：R614[医药卫生—麻醉学]