艾司氯胺酮联合右美托咪定麻醉在烧伤切痂植皮手术患者中的应用效果  

Effect of esketamine combined with dexmedetomidine anesthesia in burn patients undergoing scab resection and skin grafting

作　　者：杨海燕 陈勇 陈莉莎 YANG Haiyan;CHENG Yong;CHENG Lisha(Department of Anaesthesia,Affiliated Hospital of Southwest Jiaotong University,Chengdu,Sichuan 610031,China;Department of Anaesthesia,Dujiangyan Branch of the Third People's Hospital of Chengdu,Chengdu,Sichuan 611830,China)

机构地区：[1]西南交通大学附属医院<成都市第三人民医院>麻醉科,四川成都610031 [2]成都市第三人民医院都江堰分院<阿坝州林业中心医院>麻醉科,四川成都611830

出　　处：《医药前沿》2023年第31期13-18,共6页Journal of Frontiers of Medicine

摘　　要：目的:探讨艾司氯胺酮联合右美托咪定麻醉在烧伤切痂植皮手术患者中的应用效果。方法:选取2022年3月—2023年5月成都市第三人民医院都江堰分院的60例在气管插管全身麻醉下择期行切痂植皮术的烧伤患者,随机分为试验组和对照组,每组30例。试验组患者在麻醉过程中给予小剂量艾司氯胺酮及右美托咪定,对照组患者给予相同容量的0.9%氯化钠溶液代替艾司氯胺酮。记录麻醉诱导前(T0)、气管插管前(T1)、插管后即刻(T2)、切皮时即刻(T3)、切痂开始时(T4)、苏醒时即刻(T5)的平均动脉压(MAP)及心率(HR)。分别使用焦虑自评量表(SAS)和贝克抑郁量表(BDI-Ⅱ)评估患者术前1d、术后3d及术后7d的焦虑、抑郁状态,记录术后2、6、12、24、48h视觉模拟量表(VAS)评分,术后48h镇痛泵内舒芬太尼的消耗量及补救镇痛例数、不良反应发生情况,出院时患者和医生满意度。于术前1d、术后2h、术后3d、术后7d抽取患者静脉血,检测血清炎症因子白细胞介素-6(Il-6)和肿瘤坏死因子α(TNF-α)水平。结果:麻醉诱导前,两组患者MAP和HR比较,差异无统计学意义(P>0.05)。诱导后,试验组T1时MAP和HR高于对照组,差异有统计学意义(P<0.05),T2、T3、T4、T5时刻MAP低于对照组,差异有统计学意义(P<0.05);与T0相比,对照组T1时刻MAP和HR均明显降低,差异有统计学意义(P<0.05),其余时刻MAP均明显升高,T2、T4时刻HR升高,差异有统计学意义(P<0.05),试验组仅T2、T3、T4时刻MAP升高,T4时刻HR升高,差异有统计学意义(P<0.05)。术前1d,两组SAS及BDI-Ⅱ评分比较,差异无统计学意义(P>0.05);术后3、7d,试验组SAS及BDI-Ⅱ评分均低于对照组,差异有统计学意义(P<0.05)。试验组术后2、6、12、24、48hVAS评分均低于对照组,术后镇痛泵中舒芬太尼的消耗量以及补救镇痛的数量均少于对照组,出院时患者及术者满意度均高于对照组,差异均有统计学意义(P<0.05);两组Objective To investigate the effect of esketamine combined with dexmedetomidine anesthesia in burn patients undergoing scab resection and skin grafting.Methods From March 2022 to May 2023 in Dujiangyan Branch of Chengdu Third People's Hospital,60 burn patients who underwent selective escharectomy and skin grafting under tracheal intubation and general anesthesia were selected and randomly divided into experimental group and control group,with 30 cases in each group.Patients in the experimental group were given small doses of esketamine and dexmedetomidine during anesthesia,and patients in the control group were given the same volume of 0.9%sodium chloride solution instead of esketamine.The mean arterial pressure(MAP)and heart rate(HR)were recorded before anesthesia induction(T0),before tracheal intubation(T1),immediately after intubation(T2),immediately after skin incision(T3),at the beginning of scab incision(T4),and immediately after recovery(T5).Self-rating Anxiety Scale(SAS)and Baker Depression Scale(BDI-Ⅱ)were used to evaluate the anxiety and depression status of the patients 1 day before surgery,3 days after surgery and 7 days after surgery,respectively,and visual analog scale(VAS)scores were recorded at 2,6,12,24 and 48 hours after surgery.The consumption of sufentanil in the analgesic pump 48 h after surgery,the number of remedial analgesia cases,the occurrence of adverse reactions,the satisfaction of patients and doctors at discharge.Venous blood was collected from patients 1 day before surgery,2 h after surgery,3 days after surgery,and 7 days after surgery,and serum inflammatory factor interleukin-6(Il-6)and tumor necrosis factorα(TNF-α)levels were detected.Results Before anesthesia induction,there was no significant difference in MAP and HR between the two groups(P>0.05).After induction,MAP and HR of test groups at T1 were higher than those of control group,the difference was statistically significant(P<0.05),and MAP at T2,T3,T4 and T5 were lower than those of control group,the difference was stati

关 键 词：艾司氯胺酮 右美托咪定 烧伤 焦虑 抑郁 炎性反应 

分 类 号：R644[医药卫生—外科学]