右美托咪定复合艾司氯胺酮对老年经皮椎体成形术患者应激反应的影响  

Effect of dexmedetomidine combined with esketamine on stress reaction of elderly patients with percutaneous vertebroplasty

作　　者：刘耿 章壮云 胡建 陈晨 卞清明[2] LIU Geng;ZHANG Zhuangyun;HU Jian;CHEN Chen;BIAN Qingming(Department of Anesthesiology,Lishui District People′s Hospital of Nanjing City in Jiangsu Province,Lishui Branch of Zhongda Hospital Affiliated to Southeast University,Nanjing,Jiangsu,211200;Department of Anesthesiology,Jiangsu Cancer Hospital,Cancer Hospital Affiliated to Nanjing Medical University,Nanjing,Jiangsu,210009)

机构地区：[1]江苏省南京市溧水区人民医院/东南大学附属中大医院溧水分院麻醉科,江苏南京211200 [2]江苏省肿瘤医院/南京医科大学附属肿瘤医院麻醉科,江苏南京210009

出　　处：《实用临床医药杂志》2023年第1期79-83,91,共6页Journal of Clinical Medicine in Practice

基　　金：江苏省第五期333高层次人才项目(2018III-0169);江苏省卫生健康委干部保健科研项目(BJ20028);南京市十三五第一层次青年卫生人才项目(QRX17034);江苏大学临床医学科技发展基金项目(JLY20180214)。

摘　　要：目的 观察右美托咪定复合亚麻醉剂量艾司氯胺酮对老年经皮椎体成形术患者应激反应的影响。方法 选择择期行经皮椎体成形术的老年患者120例为研究对象,随机分为对照组、右美托咪定组、艾司氯胺酮组及复合组,每组30例。右美托咪定组、复合组在局部麻醉前10 min开始静脉泵注右美托咪定0.5μg/kg,随后按0.25μg/(kg·h)的速度持续泵注维持;艾司氯胺酮组、复合组给予艾司氯胺酮0.25 mg/kg;手术开始前,4组患者以1%盐酸利多卡因行局部浸润麻醉。记录入室5 min(T_(0))、手术开始即刻(T_(1))、穿刺针到达椎体时(T_(2))、骨水泥注入时(T_(3))、手术结束即刻(T_(4))及返回病房前(T_(5))的生命体征、疼痛视觉模拟评分法(VAS)评分及镇静Ramsay评分;检测T_(0)、T_(1)、T_(3)及T_(4)时血浆皮质醇(Cor)、血糖(Glu)、血浆肾上腺素(E)及去甲肾上腺素(NE)水平。结果 与T_(0)及右美托咪定组比较,对照组T_(1)~T_(3)时平均动脉压(MAP)、心率(HR)升高,差异有统计学意义(P<0.05);与对照组比较,右美托咪定组、艾司氯胺酮组及复合组T_(1)~T_(3)时MAP、HR降低,差异有统计学意义(P<0.05)。与T_(0)比较,对照组T_(2)~T_(3)时VAS评分升高,右美托咪定组及艾司氯胺酮组T_(2)~T_(5)时和复合组T_(1)~T_(5)时VAS评分降低,差异有统计学意义(P<0.05);与T_(0)及对照组比较,右美托咪定组、艾司氯胺酮组及复合组T_(1)~T_(5)时Ramsay评分升高,差异有统计学意义(P<0.05)。与T_(0)比较,对照组、右美托咪定组、艾司氯胺酮组T_(1)、T_(3)、T_(4)时血浆中Cor及Glu水平升高,差异有统计学意义(P<0.05);与对照组比较,右美托咪定组、艾司氯胺酮组、复合组T_(1)、T_(3)、T_(4)时血浆中Cor及Glu水平降低,差异有统计学意义(P<0.05);与T_(0)比较,对照组T_(1)、T_(3)、T_(4)时以及右美托咪定组、艾司氯胺酮组T_(1)、T_(3)时血浆中E及NE水平升高,差异有统计学意义(P<0.05);与对照组Objective To observe the effect of dexmedetomidine combined with sub-anesthetic esketamine on stress reaction of elderly patients with percutaneous vertebroplasty. Methods A total of 120 elderly patients with elective percutaneous vertebroplasty were selected as research objects, and they were randomly divided into control group, dexmedetomidine group, esketamine group and combined group, with 30 cases in each group. In the dexmedetomidine group and the combined group, 0.5 μg/kg dexmedetomidine was pumped intravenously at 10 min before local anesthesia, and then 0.25 μg/(kg·h) dexmedetomidine was pumped continuously for anesthesia maintenance;in the esketamine group and the combined group, 0. 25 mg/kg esketamine was used;before operation, thepatients in four groups were given 1% lidocaine hydrochloride for local infiltration anesthesia. Thevital signs, score of Visual Analogue Scale(VAS) for pain and Ramsay score for sedation were re-corded at the time points of 5 minutes after entering the operating room(T_(0)), the beginning of sur-gery(T_(1)), the puncture needle reaching the vertebral body(T_(2)), injection of bone cement(T_(3)),the end of surgery(T_(4)) and before returning to the ward(T_(5));the levels of plasma cortisol(Cor),blood glucose(Glu), plasma epinephrine(E) and norepinephrine(NE) were measured at T_(0), T_(1),T_(3)and T_(4).Results Compared with T_(0)and the dexmedetomidine group, the mean arterial pressure(MAP) and heart rate(HR) at T_(1)to T_(3)in the control group were significantly higher(P< 0. 05);compared with the control group, the MAP and HR at T_(1)to T_(3)in the dexmedetomidine group, theesketamine group and the combined group decreased significantly(P< 0. 05). Compared with T_(0),the VAS scores at T_(2) to T_(3)in the control group increased significantly, while the VAS scores at T_(2) to T_(5)in the dexmedetomidine group and the esketamine group as well as at T_(1)to T_(5) in the combinedgroup decreased significantly(P< 0. 05);compared with T_(0)and the control group, the Ramsayscor

关 键 词：右美托咪定 艾司氯胺酮 经皮椎体成形术 麻醉效果 应激反应 

分 类 号：R614[医药卫生—麻醉学] R681.5[医药卫生—外科学]