亚麻醉剂量艾司氯胺酮在防治妇科腹腔镜术全麻诱导后低血压中的作用  

Effect of subanesthetic dose of esketamine in prevention of hypotension after general anesthesia induction in laparoscopic gynecological surgery

作　　者：孙晓霞 张素芹 沈蓓 钱兴华[3] 肖飞[3] 夏丰[3] SUN Xiaoxia;ZHANG Suqin;SHEN Bei;QIAN Xinghua;XIAO Fei;XIA Feng(Zhejiang Chinese Medical University,Hangzhou 310053,China)

机构地区：[1]浙江中医药大学研究生院,杭州310053 [2]嘉兴市妇幼保健院 [3]嘉兴市妇幼保健院麻醉科

出　　处：《浙江医学》2023年第23期2535-2538,2544,共5页Zhejiang Medical Journal

摘　　要：目的 探讨亚麻醉剂量艾司氯胺酮在防治妇科普通腹腔镜术全麻诱导后低血压中的作用。方法 选择2022年1至12月嘉兴市妇幼保健院择期拟行全麻下子宫肌瘤剥除术、卵巢囊肿剥除术的患者79例。按随机数字表法将患者分为亚麻醉剂量艾司氯胺酮组(观察组)40例和传统方式诱导组(对照组)39例。观察组于麻醉诱导时给予艾司氯胺酮0.25 mg/kg,对照组给予0.9%氯化钠注射液0.03 mL/kg,其余麻醉诱导药物相同,均于90 s后气管插管。观察并记录两组患者入手术室时(T_(0))、气管插管时(T_(1))、插管后1 min(T_(2))、插管后5 min(T_3)、手术开始时(T_4)、手术开始后5 min(T_(5))的收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO_(2));记录两组患者的手术时间、丙泊酚使用量;观察记录两组患者复苏期间不良反应(嗜睡、恶心、呕吐、躁动等)发生情况。结果 与对照组比较,观察组患者在T_(1)、T_(2)、T_(3)时点的SBP、DBP、HR水平较高,差异均有统计学意义(均P<0.05);观察组患者苏醒期间躁动发生率降低,差异有统计学意义(P<0.05);两组患者复苏期间其他不良反应发生率比较差异均无统计学意义(均P>0.05)。结论 亚麻醉剂量艾司氯胺酮能有效防治妇科普通腹腔镜术全麻诱导后低血压,减少患者血流动力学指标波动,躁动发生率更低,并且未增加其他不良反应发生率。Objective To study the effect of subanesthetic dose of esketamine in prevention of hypotension induced by general anesthesia in laparoscopic gynecological surgery.Methods Seventy-nine patients undergoing gynecological laparoscopic surgery(myomectomy and ovarian cystectomy)were randomly divided into trial group(n=40)and control group(n=39)in Jiaxing Maternity and Child Health Care Hospital from January to December 2022.Additional 0.25 mg/kg esketamine was given to trial group,while equal amount normal saline was given to the control group instead.For general anesthesia induction,after 90 s patients were intubated.The systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)and pulse oxygen saturation were recorded at the time of entering the operating room(T_(0)),immediately after endotracheal intubation(T_(1)),and 1 min after intubation(T_(2)),5 min after intubation(T_(3)),surgical skin incision(T_(4)),5 min after surgical skin incision(T_(5)).The operation duration and the total dosage of propofol;adverse reactions(somnolence,delirium,excessive secretion,nausea and vomiting,emergence agitation)during resuscitation were also documented in both groups.Results Compared to the control group,the SBP,DBP and HR of the trial group were higher at T_(1),T_(2) and T_(3)(all P<0.05);the incidence of emergence agitation was lower(P<0.05).There were no significant differences in the incidence of other adverse reactions during resuscitation between two groups(both P>0.05).Conclusion Subanesthetic dose of esketamine can effectively reduce the hemodynamic fluctuation of patients during general anesthesia induction in laparoscopic gynecological surgery without increasing adverse reactions.

关 键 词：艾司氯胺酮 诱导后低血压 全麻 亚麻醉剂量 

分 类 号：R614[医药卫生—麻醉学]