亚麻醉剂量艾司氯胺酮复合丙泊酚-瑞芬太尼在老年患者纤维支气管镜检查术中的应用  

Application of subanesthetic dose of esketamine combined with propofol-remifentanil in elderly patients undergoing fiberoptic bronchoscopy

作　　者：吕婷敏 彭祝丁 唐镇宇 万婷婷 邱文蕊 张奕文 陈汉文 LYU Tingmin;PENG Zhuding;TANG Zhenyu;WAN Ting-ting;QIU Wenrui;ZHANG Yiwen;CHEN Hanwen(Department of Anesthesiology,Affiliated Shunde Hos-pital of Southern Medical University,Foshan 528300,China)

机构地区：[1]南方医科大学顺德医院麻醉科,佛山市528300

出　　处：《临床麻醉学杂志》2022年第12期1264-1268,共5页Journal of Clinical Anesthesiology

基　　金：广东省医学科学技术研究基金项目(A2019045);佛山市卫健局医学科研课题(20190332);佛山市“十三五”重点专科资助项目(FSZDZK135049);佛山市杰出青年医学人才项目(600007)。

摘　　要：目的探讨亚麻醉剂量艾司氯胺酮复合丙泊酚-瑞芬太尼在老年患者纤维支气管镜检查术中的应用效果。方法选择择期行纤维支气管镜检查术老年患者114例,年龄65~80岁,BMI 18~25 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组:艾司氯胺酮组(E组)和对照组(C组),每组57例。麻醉诱导前E组静脉注射艾司氯胺酮0.2 mg/kg,C组给予等容量生理盐水,两组均在Marsh模式下靶控输注(TCI)丙泊酚效应室浓度3μg/ml,Minto模型TCI瑞芬太尼效应室浓度4 ng/ml,入镜后调整丙泊酚和瑞芬太尼效应室浓度分别为1.5~3μg/ml和2~4 ng/ml。记录入室后安静10 min(T_(0))、睫毛反射消失时(T_(1))、至声门时(T_(2))、至隆突时(T_(3))、术毕时(T_(4))、拔除喉罩时(T_(5))的HR、MAP、SpO_(2)和Narcotrend指数(NI)。记录术中丙泊酚和瑞芬太尼用量。记录呛咳、支气管痉挛、低血压、低氧血症、术后咽痛等不良反应发生情况。结果与T_(0)时比较,T_(1)时E组HR明显增快,MAP明显升高(P<0.05);T_(1)时C组HR明显减慢,MAP明显降低(P<0.05),T_(2)、T_(3)时C组MAP明显升高(P<0.05)。与C组比较,E组低血压发生率明显降低,丙泊酚、瑞芬太尼用量明显减少,呛咳、支气管痉挛和术后咽痛发生率明显降低(P<0.05)。结论亚麻醉剂量(0.2 mg/kg)艾司氯胺酮复合TCI丙泊酚-瑞芬太尼可安全有效地用于老年患者纤维支气管镜检查术,可减少丙泊酚与瑞芬太尼用量,且血流动力学平稳,不良反应少。Objective To investigate the effect of esketamine combined with propofol-remifentanil in elderly patients undergoing fiberoptic bronchoscopy.Methods A total of 114 elderly patients,aged 65-80 years,BMI 18-25 kg/m^(2),ASA physical statusⅡorⅢ,scheduled for fiberoptic bronchoscopy were selected.The patients were divided into two groups by random number table:esketamine group(group E)and control group(group C),57 patients in each group.During anesthesia induction,group E was given esketamine 0.2 mg/kg intravenously,and group C was given equal volume normal saline.Under Marsh mode,the concentration of propofol effect chamber in target controlled infusion(TCI)was 3μg/ml,and the concentration of remifentanil effect chamber in Minto model was 4 ng/ml.After the fiberoptic bronchoscope entered,the effect chamber concentrations of propofol and remifentanil were adjusted to 1.5-3μg/ml and 2-4 ng/ml respectively.HR,MAP,SpO_(2),and Narcotrend index(NI)were also recorded at following time points:after the patient entered the room was quiet for 10 minutes(T_(0)),the time of eyelash reflex disappeared(T_(1)),the time when fibrobronchoscope reaching glottis(T_(2)),the time when fibrobronchoscope reaching carina(T_(3)),end of the surgery(T_(4)),after extubation(T_(5)).The dosage of propofol and remifentanil were recorded.The adverse reactions including cough,bronchospasm,hypotension,hypoxemia,postoperative throat sore were recorded.Results Compared with T_(0),HR and MAP in group E were increased significantly at T_(1)(P<0.05),HR and MAP in group C were decreased significantly at T_(1)(P<0.05),and MAP in group C was increased significantly at T_(2)and T_(3)(P<0.05).Compared with group C,the incidence of hypotension in group E was lower,and the dosage of propofol and remifentanil was decreased significantly(P<0.05).Compared with group C,the incidence of cough,bronchospasm and postoperative throat sore in group E decreased significantly(P<0.05).Conclusion Subanesthetic dose of esketamine(0.2 mg/kg)combined with TCI propofol-remi

关 键 词：亚麻醉剂量 艾司氯胺酮 低血压 纤维支气管镜检查术 老年 

分 类 号：R614[医药卫生—麻醉学]