小剂量氯胺酮辅助硬膜外麻醉在阑尾炎腹腔镜手术中的应用效果评价  

Evaluation of Low-dose Ketamine Assisted Epidural Anesthesia in Laparoscopic Appendectomy for Appendicitis

作　　者：韩雪 杜传昱 HAN Xue;DU Chuan-Yu(Department of Anesthesiology,Jingshan People's Hospital,Jingmen 431800,Hubei Province,China)

机构地区：[1]京山市人民医院麻醉科,湖北荆门431800

出　　处：《罕少疾病杂志》2023年第1期63-64,74,共3页Journal of Rare and Uncommon Diseases

摘　　要：目的 探讨阑尾炎腹腔镜手术患者实施硬膜外麻醉辅助小剂量氯胺酮的临床价值。方法 筛选100例接受腹腔镜手术治疗的阑尾炎患者(2020年1月至2022年1月),在“随机数字表法”原则下分为2组一对照组与观察组,对照组实行硬膜外麻醉,观察组在硬膜外麻醉中辅助小剂量氯胺酮,各组病例均50例;评估两组镇静效果、术后遗忘优良率、生命体征指标、不良反应率、炎症因子水平并展开组间比较。结果 观察组气腹时、阑尾系膜分离时生命体征即心率、平均动脉压、血氧饱和度水平均较对照组同时段更优(P<0.05);较对照组结果 ,观察组术中镇静优良率明显高,同时麻醉恢复、患者拔管、患者清醒及自主呼吸恢复的时间均更短,术后遗忘优良率显著高(P<0.05);观察组较对照组术后1h血清IL-6、TNF-α水平更低,且不良反应率明显低(P<0.05)。结论 小剂量氯胺酮用于阑尾炎腹腔镜手术硬膜外麻醉中,可以提高麻醉效果,稳定患者生命体征,同时控制恶心呕吐、牵拉反射等不良反应的发生,确保手术顺利开展,具有应用推广的价值。Objective To explore the clinical value of epidural anesthesia assisted with small dose ketamine in patients with laparoscopic appendectomy for appendicitis.Methods A total of 100 patients with appendicitis undergoing laparoscopic surgery(January 2020 to January 2022)were screened and divided into two groups according to the principle of"random number table":control group and observation group.The control group received epidural anesthesia,and the observation group received epidural anesthesia assisted with low-dose ketamine,with 50 cases in each group.Sedation effect,excellent and good rate of postoperative amnesia,vital signs,adverse reaction rate and inflammatory factor levels were evaluated and compared between the two groups.Results The vital signs of the observation group were better than those of the control group in pneumoperitoneum and appendiceal mesangial separation(P<0.05).Compared with the control group,the excellent and good rate of sedation was significantly higher in the observation group,and the recovery time of anesthesia,extubation,awake and spontaneous breathing was shorter in the observation group,and the good and good rate of postoperative amnesia was significantly higher(P<0.05).The levels of serum IL-6 and TNF-αin the observation group were lower than those in the control group at 1h after operation,and the rate of adverse reactions was significantly lower(P<0.05).Conclusion The use of low-dose ketamine in epidural anesthesia of laparoscopic appendectomy for appendicitis can improve the anesthetic effect,stabilize patients'vital signs,control the occurrence of adverse reactions such as nausea and vomiting,pull reflex,and ensure the smooth operation,which has the value of application and promotion.

关 键 词：小剂量 氯胺酮 硬膜外麻醉 阑尾炎 腹腔镜手术 

分 类 号：R614.2[医药卫生—麻醉学]