艾司氯胺酮麻醉诱导用于腰椎手术的临床体会  

Clinical effects of esketamine in induction of general anesthesia for lumbar surgery

作　　者：鞠衍馨[1] 于凯华 田德民[2] 刘志武[1] Ju Yanxin;Yu Kaihua;Tian Demin;Liu Zhiwu(Department of Anesthesiology,970th Hospital of the PLA,Yantai 264100,China;Department of Painology,Weihai Municipal Hospital,Weihai 264200,China)

机构地区：[1]中国人民解放军第九七零医院麻醉科,烟台264100 [2]威海市立医院疼痛科,威海264200

出　　处：《国际医药卫生导报》2022年第23期3359-3362,共4页International Medicine and Health Guidance News

摘　　要：目的观察艾司氯胺酮麻醉诱导对血流动力学、腰椎手术术后拔管期的影响,探讨艾司氯胺酮麻醉诱导的临床效果。方法选择解放军第970医院择期全身麻醉下行腰椎手术的患者60例,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级标准Ⅰ~Ⅱ级,采用随机数字法分为艾司氯胺酮组(E组)和芬太尼组(F组),各30例。E组男16例,女14例,年龄(58.0±7.5)岁;F组男18例,女12例,年龄(57.4±7.2)岁。麻醉诱导时,所有患者均静脉注射依托咪酯0.3 mg/kg、苯磺酸顺阿曲库铵0.3 mg/kg,E组伍用艾司氯胺酮0.5 mg/kg,F组伍用芬太尼5μg/kg行麻醉诱导气管插管。观察并记录两组患者麻醉诱导前(T0)、诱导后气管插管前即刻(T1)、插管完成后1 min(T2)、5 min(T3)心率(heart rate,HR)和平均动脉压(mean arterial pressure,MAP)等血流动力学变化、术后拔管时间、术后准确活动双下肢时间及不良反应情况。采用单因素方差分析、独立样本t检验和χ^(2)检验。结果两组患者T0时HR、MAP比较,差异均无统计学意义(均P>0.05);两组患者T1时MAP较T0时均显著降低[E组(90.5±7.9)mmHg(1 mmHg=0.133 kPa)比(99.6±8.2)mmHg、F组(89.0±9.8)mmHg比(97.5±5.7)mmHg,均P<0.05];气管插管后,E组患者MAP快速回升,T2[(101.4±10.9)mmHg]、T3[(99.5±7.3)mmHg]时点同T0时比较,差异均无统计学意义(均P>0.05);F组患者T2[(91.5±6.9)mmHg]、T3[(92.1±7.9)mmHg]时同T0时比较仍显著降低,差异均有统计学意义(均P<0.05)。麻醉诱导后,F组患者HR波动较为明显,T1时[(61.4±7.5)次/min]较T0时[(67.7±10.7)次/min]显著降低,插管后T3时[(73.1±10.1)次/min]较T0时显著升高,差异均有统计学意义(均P<0.05);E组患者各时点HR均无显著变化(均P>0.05)。E组患者术后拔管时间及拔管后准确活动双下肢时间均显著低于F组[(10.3±0.8)min比(13.5±1.5)min、(7.9±2.3)min比(9.1±2.8)min],差异有统计学意义(均P<0.05)。E组患者苏醒期躁动不良反应发生率显�Objective To observe the effect of esketamine in induction of general anesthesia for lumbar surgery on hemodynamics and the extubation period.Methods A total of 60 patients[American Society of Anesthesiologists(ASA)ⅠorⅡ]who were scheduled to undergo lumbar surgery under general anesthesia at 970th Hospital of the PLA were enrolled in this study.They were divided into an esketamine group(group E)and a fentanyl group(group F)by the random number table method,with 30 cases in each group.There were 16 males and 14 females in group E,and they were(58.0±7.5)years old.There were 18 males and 12 females in group F,and they were(57.4±7.2)years old.During induction of anesthesia,etomidate 0.3 mg/kg and atracurium 0.3 mg/kg were intravenously injected in all the patients,and group E took esketamine 0.5 mg/kg and group F took fentanyl 5μg/kg.The hemodynamic changes,such as heart rate(HR)and mean arterial pressure(MAP),were observed and recorded before anesthesia induction(T0),immediately before endotracheal intubation(T1),and 1 min(T2)and 5 min(T3)after intubation.The extubation times and accurate activity times of both lower limbs,and postoperative adverse reactions in both groups were recorded.One-way ANOVA,t test,andχ^(2) test were applied.Results There were no statistical differences in HR and MAP between two groups at T0(both P>0.05).The MAP's in group E[(90.5±7.9)mmHg vs.(99.6±8.2)mmHg]and group F[(89.0±9.8)mmHg vs.(97.5±5.7)mmHg]at T1 were significantly lower than those at T0(both P<0.05).The MAP recovered rapidly in group E after endotracheal intubation,and the MAP's at T2[(101.4±10.9)mmHg]and T3[(99.5±7.3)mmHg]were not statistically different from that at T0(both P>0.05).The MAP's at T2[(91.5±6.9)mmHg]and T3[(92.1±7.9)mmHg]of group F were significantly lower than that at T0(both P<0.05).After induction of anesthesia,the HR at T1[(61.4±7.5)beats/min]was significantly lower and the HR at T3[(73.1±10.1)beats/min]was significantly higher than that at T0[(67.7±10.7)beats/min]in group F(both P<0.05).The

关 键 词：艾司氯胺酮 全身麻醉 麻醉诱导 血流动力学 腰椎手术 

分 类 号：R614[医药卫生—麻醉学]