小剂量艾司氯胺酮用于困难气道患者插管的安全性与有效性分析  

Safety and efficacy analysis of the use of low-dose esketamine in patients with difficult airway

作　　者：韩晓菲 扈大为[1] 潘楚雄 HAN Xiao-fei;HU Da-wei;PAN Chu-xiong(Department of Anesthesiology,Beijing Stomatological Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学口腔医学院麻醉科,北京100050

出　　处：《北京口腔医学》2024年第1期34-38,共5页Beijing Journal of Stomatology

摘　　要：目的 分析小剂量艾司氯胺酮用于困难气道患者纤维支气管镜引导下经鼻插管的安全性与有效性。方法 选取2020年6月至2022年11月我院360例择期行纤维支气管镜引导下经鼻插管的困难气道患者,以随机数字表法分为对照组、观察A组、观察B组,每组120例,分别给予环甲膜穿刺丁卡因、环甲膜穿刺丁卡因+0.5 mg/kg艾司氯胺酮、环甲膜穿刺丁卡因+1 mg/kg艾司氯胺酮,观察比较三组插管情况、血流动力学、镇静镇痛效果及不良反应。结果 观察A组、B组插管时间明显短于对照组,插管成功率、满意度明显高于对照组(P<0.05)。观察A组与观察B组的丁卡因剂量明显低于对照组(P<0.05)。三组T1、T2、T3、T4的心率、平均动脉压比较,均观察B组<观察A组<对照组(P<0.05)。术后1 h、术后6 h、术后12 h的Ramsay评分比较,均观察B组>观察A组>对照组(P<0.05)。术后1 h、术后6 h、术后12 h的VAS评分比较,均观察B组<观察A组<对照组(P<0.05)。术后不良反应发生情况比较,观察B组明显高于观察A组和对照组。结论困难气道患者纤维支气管镜引导下经鼻插管采用小剂量(0.5 mg/kg)艾司氯胺酮即可到达满意的镇静镇痛效果,提高插管成功率,而大剂量(1 mg/kg)虽有利于稳定患者血流动力学,但易发生过度镇静及不良反应。Objective To analyze the safety and effectiveness of low-dose esketamine for nasal intubation guided by fiberoptic bronchoscope in patients with difficult airways.Methods A total of 360 patients with difficult airway were divided into observation group A,observation group B,and control group,given tetracaine cricothyrocentesis,tetracaine cricothyrocentesis+0.5 mg/kg esketamine,and tetracaine cricothyrocentesis+1 mg/kg esketamine,respectively.Intubation,hemodynamics,sedative and analgesic effects and adverse reactions were observed.Results The intubation time of observation group A and B was significantly shorter than that of the control group.The intubation success rate and satisfaction rate were significantly higher than those of the control group(P<0.05).The tetracaine dose in observation group A and B was significantly lower than that of the control group(P<0.05).HR and MAP of the three groups T1,T2,T3,T4 were as follows,observe group B<observation group A<control group(P<0.05).The Ramsay scores at 1 h,6 h,and 12 h after surgery were observe group B>observation group A>control group(P<0.05).The VAS scores at 1 h,6 h,and 12 h after surgery were group B<observed group A<control group(P<0.05).The postoperative adverse reaction in group B was significantly higher than that observe group A and control group.Conclusions In patients with difficult airways,a small dose(0.5 mg/kg)of esketamine can be used to achieve satisfactory sedation and analgesia and improve the success rate of intubation.Although high-dose(1 mg/kg)is beneficial for stabilizing patient hemodynamics,it is prone to excessive sedation and adverse reactions.

关 键 词：艾司氯胺酮 剂量 困难气道 纤维支气管镜 经鼻插管 

分 类 号：R614.2[医药卫生—麻醉学]