艾司氯胺酮用于老年胸腰椎骨折手术对患者术中血流动力学和术后谵妄的影响  

Influence of esketamineused in elderly thoracolumbar fracture surgery on intraoperative hemodynamics and postoperative delirium in patients

作　　者：吴克义 黄勇 许成浩 马天鸣 胡成云 代飞彪 李雪[2] 唐朝亮 WU Ke-yi;HUANG Yong;XU Cheng-hao;MA Tian-ming;HUCheng-yun;DAI Fei-biao;LI Xue;TANG Chao-iang(Department of Anesthesiology,Anhui Lujiang General Hospital,Anhui,231500,China;Department of Anesthesiology,the First)

机构地区：[1]安徽省庐江县人民医院麻醉科,安徽合肥231500 [2]中国科学技术大学附属第一医院麻醉科,安徽合肥230001

出　　处：《颈腰痛杂志》2023年第3期361-365,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：安徽省自然科学基金优青项目(编号:2208085Y32);湖北陈孝平科技发展基金会资助项目(编号:CXPJJH12000005-07-115)。

摘　　要：目的艾司氯胺酮用于老年胸腰椎骨折手术对患者术中血流动力学、术后谵妄的影响。方法选择50例老年胸腰椎骨折手术患者作为研究对象,按照随机数字表法将患者分为两组各25例,对照组采用常规方式进行麻醉诱导与维持,研究组在对照组基础上加用艾司氯胺酮。比较两组围手术期指标,术中血流动力学,术后镇痛效果,手术前后血清应激反应,不良反应发生率。结果研究组拔管时间、苏醒时间、术后48 h内镇痛泵按压次数少于对照组(P<0.05);两组切皮即刻(T_(2))、拔管即刻(T_(3))时的心率(heart rate,HR)显著低于入室时(T_(0)),平均动脉压(mean arterial pressure,MAP)水平显著高于T_(0)时,且研究组T_(2)、T_(3)时HR显著高于对照组,MAP显著低于对照组(P<0.05);研究组术后3 h、12 h、24 h的VAS评分显著低于对照组(P<0.05);研究组术后30 min的血清皮质醇(cortisol,Cor)、去甲肾上腺素(norepinephrine,NE)以及肾上腺素(epinephrine,E)显著低于对照组(P<0.05);研究组不良反应发生率显著低于对照组(8.00%vs 32.00%;P<0.05)。两组谵妄发生率比较,差异无统计学意义(4.00%vs 24.00%;P>0.05)。结论老年胸腰椎骨折手术时使用艾司氯胺酮,有助于保证术中血流动力学稳定,麻醉镇痛效果优异,且不会增加患者术后谵妄的发生风险。Objective To investigate the influence of esketamine used in elderly thoracolumbar fracture surgery on intraoperative hemodynamics and postoperative deliriuminpatients.Methods A total of 50 elderly patients who underwent thoracolumbar fracture surgery were selectedand divided into two groups by random number table methodwith 25 cases in each group.The control group received conventional anesthesia inductionand maintenance.On this basis,patients in the study group were treated with esketamine.The perioperative indicators,intraoperative hemodynamics,postoperative analgesic effect,serum stress response indicators before and after surgery,and the incidence of adverse reactions were compared between the two groups.Results The extubation time,recovery time and the use frequency of patient-controlled analgesia within 48h after operation of thestudy group were shorter/lower than those of the control group(P<0.05).HR of the two groups was lower,and MAP was higherat skin incision(T_(2))andat extubation(T_(3))than at the time of entering the room(T_(0)).The study group had higher HR and lower MAP than the control group at T_(2)and T_(3)(P<0.05).The study group had lower VAS scores than the control groupat 3h,12h and 24h after operation(P<0.05).The levels of serum cortisol(Cor),norepinephrine(NE)and epinephrine(E)were lower in the study group than in the control group 30 minutes after operation(P<0.05).The incidence rate of adverse reactions in the study group was significantly lower than that in the control group(8.00%vs 32.00%,P<0.05),but there was no significant difference in the incidence of delirium(4.00%vs 24.00%,P>0.05).Conclusion The application ofesketamine in elderly thoracolumbar fracture surgery can help to maintain hemodynamicstability.It can achieve excellent analgesic effectwithout increasing the incidence of postoperative delirium.

关 键 词：艾司氯胺酮 胸腰椎骨折 老年 血流动力学 谵妄 

分 类 号：R614[医药卫生—麻醉学]