腰椎手术麻醉方法的改良:艾司氯胺酮复合麻醉  

Improvement in anesthesia method for lumbar spine surgery:esketamine-based anesthesia

作　　者：汪美如 孙斌 苏丹丹 赵倩文 陆峣 薛欢家 王立伟 Wang Meiru;Sun Bin;Su Dandan;Zhao Qianwen;Lu Yao;Xue Huanjia;Wang Liwei(Xuzhou Clinical College,Xuzhou Medical University,Xuzhou 221009,China;Department of Anesthesiology,Xuzhou Central Hospital,Xuzhou 221009,China;School of Anesthesiology,Xuzhou Medical University,Xuzhou 221009,China)

机构地区：[1]徐州医科大学徐州临床学院,徐州221009 [2]徐州市中心医院麻醉科,徐州221009 [3]徐州医科大学麻醉学院,徐州221009

出　　处：《中华麻醉学杂志》2023年第9期1082-1086,共5页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(82071903);徐州市科技计划项目(KC20071)。

摘　　要：目的评价艾司氯胺酮复合麻醉用于腰椎手术的改良效果。方法选择2022年6月至12月拟在全身麻醉下行腰椎后路减压植骨融合内固定术患者94例,性别不限,年龄18~64岁,BMI 18.5~29.9 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=47):对照组(C组)和艾司氯胺酮组(K组)。2组静脉注射咪达唑仑、舒芬太尼、依托咪酯及顺式阿曲库铵进行麻醉诱导,K组在此基础上静脉注射艾司氯胺酮0.5 mg/kg。2组均静脉输注丙泊酚和瑞芬太尼维持麻醉,间断静脉注射顺苯磺酸阿曲库铵维持肌松,K组在此基础上静脉输注艾司氯胺酮0.25 mg·kg^(-1)·h^(-1)。术毕前10 min连接镇痛泵行PCIA,NRS评分>4分时静脉注射氟比洛芬酯50 mg进行补救镇痛。记录首次按压镇痛泵时间、术后48 h内镇痛泵按压次数和补救镇痛情况;记录术中瑞芬太尼初始剂量、瑞芬太尼累计用量、气管拔管时间及术后48 h内不良反应发生情况。结果与C组比较,K组术中瑞芬太尼累计用量减少,首次按压镇痛泵时间延长,镇痛泵按压次数减少(P<0.05),术中瑞芬太尼初始剂量、术后补救镇痛率、气管拔管时间和术后不良反应发生率差异无统计学意义(P>0.05)。结论艾司氯胺酮复合麻醉用于腰椎手术可减少术中阿片类药物用量,延缓术后疼痛时间,减轻术后早期疼痛。Objective To evaluate the efficacy of esketamine-based anesthesia in lumbar spine surgery.Methods Ninety-four patients of both sexes,aged 18-64 yr,with body mass index of 18.5-29.9 kg/m2,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,scheduled for elective lumbar posterior decompression bone grafting fusion internal fixation under general anesthesia from June 2022 to December 2022,were divided into control group(group C)and esketamine group(group K)using a random number table method,with 47 cases in each group.Midazolamm,sufentanil,etomidate and cisatracurium were intravenously injected for anesthesia induction in both groups,and esketamine 0.5 mg/kg was intravenously injected on this basis in group K.Propofol and remifentanil were intravenously infused to maintain anesthesia,and cisatracurium besylate was intermittently injected to maintain muscle relaxation in both groups,and esketamine 0.25 mg·kg^(-1)·h^(-1)was intravenously infused on this basis in group K.The patients were connected to an analgesic pump for patient-controlled intravenous analgesia at 10 min before the end of surgery,and flurbiprofen axetil 50 mg was intravenously injected for rescue analgesia when the numeric rating scale score>4.The time of first pressing the analgesia pump,effective pressing times of the analgesia pump within 48 h after operation and requirement for rescue analgesia were recorded.The initial dose of remifentanil,cumulative amount of remifentanil used during operation,time of tracheal extubation,and adverse reactions within 48 h after surgery were recorded.Results Compared with group C,the cumulative use of remifentanil during operation was significantly reduced,the time of first pressing the self-control button of the analgesia pump after surgery was prolonged,the pressing times of the analgesia pumps were decreased(P<0.05),and no significant change was found in terms of the initial dose of intraoperative remifentanil,rate of postoperative rescue analgesia,time of extubation,and incidence

关 键 词：氯胺酮 麻醉 全身 腰椎手术 

分 类 号：R614[医药卫生—麻醉学]