艾司氯胺酮预处理对全麻下使用止血带患者血流动力学的影响  

Impact of Esketamine on Tourniquet-Induced Hemodynamic Effects in Orthopedic Patients under General Anesthesia

作　　者：余璞琳 镇路明 吴刚[1] 丁晓英[1] 魏海东[1] YU Pulin;ZHEN Luming;WU Gang;DING Xiaoying;WEI Haidong(Department of Anesthesiology,Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院麻醉科,西安710004

出　　处：《药学与临床研究》2023年第2期110-113,共4页Pharmaceutical and Clinical Research

摘　　要：目的:探讨艾司氯胺酮预处理对全麻下使用下肢止血带骨科手术患者血流动力学的影响。方法:纳入应用气压止血带行下肢骨科择期手术的患者60例,随机分为艾司氯胺酮组(E组)和对照组(C组)各30例。止血带充气后E组静脉注射艾司氯胺酮0.2 mg·kg^(-1),C组给予等量生理盐水。记录患者入室时(T1)、插管成功后10 min(T2)、止血带加压时(T3)、止血带加压后30 min(T4)、45 min(T5)、60 min(T6)、松止血带时(T7)、松止血带后5 min(T8)的血压、心率、脑电双频指数和心肌耗氧量。结果:E组有2例患者出现了止血带相关性高血压(6.67%),少于C组的12例(40.00%)(P<0.01)。与T1相比,E组在T4的收缩压明显降低(P<0.05),在T7则明显升高(P<0.05),而在C组,T5、T6、T7的收缩压和舒张压与T1相比均明显增高(P<0.05)。结论:对全麻下使用下肢止血带的骨科手术患者用艾司氯胺酮进行预处理,能有效减少止血带相关高血压的几率,使患者术中生命体征趋于平稳。Objective:To investigate the hemodynamic effect of esketamine pretreatment on orthopedic surgery patients with lower extremity tourniquet under general anesthesia.Methods:A total of 60 patients undergoing selective lower extremity orthopedic surgery using barometric tourniquet were randomly divided into esketamine group(group E,n=30)and control group(group C,n=30).After the tourniquet was inflated,esketamine 0.2 mg·kg^(-1)was given intravenously in group E,and the same amount of normal saline was given in group C.SBP,DBP,HR,BIS and RPP were recorded at the time of admission(T1),10 min after successful intubation(T2),when the tourniquet was pressurized(T3),T3+30 min(T4),T3+45 min(T5),T3+60 min(T6),when the tourniquet was loosened(T7),and 5 min after the tourniquet was loosened(T8).Results:Only two patients in group E developed tourniquet-related hypertension(6.67%),which was less than 12 patients(40%)in group C(P<0.05).Compared with T1,the systolic blood pressures of group E at T4 were significantly reduced(P<0.05),and systolic blood pressures at T7 were significantly increased(P<0.05).In group C,the systolic and diastolic blood pressures of T5,T6 and T7 were significantly increased compared with T1(P<0.05).Conclusion:Esketamine pretreatment for orthopedic patients who use lower extremity tourniquets under general anesthesia can effectively reduce the incidence of tourniquet-associated hypertension after using tourniquets during orthopedic surgery,and stabilize their intraoperative vital signs.

关 键 词：艾司氯胺酮 止血带 止血带相关高血压 全身麻醉 

分 类 号：R969.3[医药卫生—药理学] R614.2[医药卫生—药学]