小剂量艾司氯胺酮对髂动脉狭窄行手术治疗的老年患者呼吸循环和疼痛的影响  

Effects of low-dose Esketamine on respiration, circulation and pain in elderly patients undergoing surgical treatment for iliac artery stenosis

作　　者：刘文君 林多茂[1] 赵丽云[1] 马骏[1] Liu Wenjun;Lin Duomao;Zhao Liyun;Ma Jun(Center for Anesthesiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院麻醉中心,北京100029

出　　处：《中华老年医学杂志》2022年第6期704-709,共6页Chinese Journal of Geriatrics

基　　金：北京市医院管理局临床医学发展专项经费资助(ZYLX201810);国家自然科学基金(82172151)。

摘　　要：目的观察小剂量艾司氯胺酮对髂动脉狭窄老年患者行外周血管介入术时呼吸、循环功能和疼痛的影响,为艾司氯胺酮更加合理安全地应用于老年患者麻醉提供参考。方法选取首都医科大学附属北京安贞医院40例髂动脉狭窄老年患者,择期行球囊经皮血管腔内成型术(PTA)及支架置入术治疗,其中男33例、女7例,美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级,采用随机数字法随机分为两组,每组20例,对照组静脉给予2 ml生理盐水,艾司氯胺酮组静脉给予艾司氯胺酮0.25 mg/kg,静脉缓慢给药(1 min内给药完毕)。患者入手术室后,动脉血压、心率趋于稳定时,收集两者的数值作为试验基础值(T0)。外科大夫扩张髂动脉狭窄前5 min,两组按试验要求给予静脉麻醉药。扩张髂动脉狭窄前5 min作为T1、前4 min为T2、前3 min为T3、第25 min为T30,以此类推一共记录25 min的血压、心率数值并分析,分别于患者入手术室后(M1)、给药后5 min(M2)、给药后10 min(M3)抽取动脉血进行血气分析。所有患者均在扩张髂动脉时采用口述评分法记录患者的疼痛程度,记录患者从扩张髂动脉开始到手术结束血管活性药物的用量。结果对照组中,与M1时间点比较,M2时PaO2升高(P=0.003);艾司氯胺酮组中,与M1时间点比较,M2时PaCO_(2)升高(P=0.011)。在T4时间点,与对照组比较,艾司氯胺酮组收缩压、舒张压升高(t=2.403、2.119,均P<0.05);在T3时间点,与对照组比较,艾司氯胺酮组心率升高(t=0.789,P=0.007);与对照组比较,T6~T15时间点艾司氯胺酮组收缩压降低(t=3.143、2.403、2.272、3.460、2.610、2.568、2.453、2.367、2.282、2.187,均P<0.05),T8~T16时间点艾司氯胺酮组舒张压较低,差异有统计学意义(t=3.880、6.602、2.967、3.243、2.641、3.253、3.114、4.521、2.659,均P<0.05),T7~T13时间点艾司氯胺酮组心率降低(t=2.246、3.285、3.207、2.752、2.725、2.713、2.473,均P<0.05)。与对照组比较,艾司氯�Objective To examine the effects of low-dose Esketamine on circulatory function,respiratory function and pain in elderly patients undergoing peripheral vascular interventions,and to provide evidence for appropriate and safe use of Esketamine in elderly patients under anesthesia.Methods Forty elderly patients with iliac artery stenosis at Beijing Anzhen Hospital affiliated to the Capital Medical University were enrolled and treated with balloon percutaneous transluminal angioplasty(PTA)and stent implantation on a selective basis.Among them,33 were male and 7 were female with American Society of Anesthesiologists(ASA)physical classification ofⅡ-Ⅲ.The patients were randomly divided into two groups(20 in each group)using the randomized number method,with the control group(Group C)given 2 ml normal saline intravenously and the Esketamine group(Group L)given Esketamine 0.25 mg/kg intravenously(slow intravenous administration within 1 min).Values of arterial blood pressure and heart rate in stabilized condition in the operating room were collected as the baseline(T0).Five minutes before the surgeon dilated the stenosed iliac artery,intravenous anesthetics were given in both groups as required for the trial.The first 5 minutes before dilatation of the stenosed iliac artery was used as T1,the first 4 minutes as T2,and the first 3 minutes as T3.The recording continued until the 25th minute after anesthetic administration as T30,with a collection of 25-minute blood pressure and heart rate values for analysis.Blood gas analysis was made for arterial blood samples drawn at the time patients entered the operating room(M1),5 minutes after drug administration(M2),and 10 minutes after drug administration(M3).For all patients,the pain level was recorded using a self-reported scale while the iliac artery was dilated.The doses of vasoactive drugs were recorded from the beginning of the dilatation of the iliac artery to the end of the procedure in patients.Results In Group C,PaO2 at M2 was elevated compared with at M1(P=0.003);In

关 键 词：氯胺酮 血管成形术 气囊 

分 类 号：R654.3[医药卫生—外科学]