亚麻醉剂量艾司氯胺酮用于股骨骨折手术患者麻醉前摆放体位时的镇痛效果  

Analgesic effect of sub-anesthetic dose of esketamine during positioning of patients before femoral fracture surgery

作　　者：黄瑞鑫[1] 李春然 许晓敏 杨铎 林耿彬[1] 江燕[1] 张隆盛[1] Huang Ruixin;Li Chunran;Xu Xiaomin;Yang Duo;Lin Gengbin;Jiang Yan;Zhang Longsheng(Department of Anesthesiology,Jieyang People's Hospital,Jieyang,Guangdong 522000,China)

机构地区：[1]揭阳市人民医院麻醉科,广东揭阳522000

出　　处：《齐齐哈尔医学院学报》2024年第12期1132-1135,共4页Journal of Qiqihar Medical University

基　　金：广东省医学科学技术研究基金[B2022294,A2021400];广东省中医药局面上科研项目[20191409,20201463]。

摘　　要：目的探讨亚麻醉剂量艾司氯胺酮预处理用于股骨骨折手术患者麻醉前摆放体位时的镇痛效果。方法选择2021年3月—2024年3月本院收治的择期股骨骨折手术切开复位内固定手术患者60例作为研究对象,随机分为观察组和对照组两组,每组各30例。观察组在实施腰硬联合麻醉前静脉注射艾司氯胺酮0.125 mg/kg,对照组则静脉注射等量生理盐水,两组患者在注药后15 min摆放侧卧位进行腰硬联合麻醉。记录两组患者入手术室、艾司氯胺酮注射后10 min、摆体位时、麻醉后的疼痛VAS评分和Ramsay镇静评分;记录两组患者腰硬联合麻醉操作时间、患者的麻醉满意度评分;记录两组患者围术期麻醉相关不良反应发生率,主要包括恶心、呕吐、头痛、低血压、谵妄等。结果观察组患者在摆体位时疼痛VAS评分较对照组明显降低(P<0.05),其余时间点两组患者疼痛VAS评分比较均无明显差异(P>0.05);观察组患者在摆体位时、麻醉后Ramsay镇静评分较对照组明显升高(P<0.05),两组患者入手术室时Ramsay镇静评分比较无明显差异(P>0.05);观察组患者腰硬联合麻醉操作时间较对照组明显缩短(P<0.05),麻醉满意度较对照组明显升高(P<0.05);两组患者围术期麻醉相关不良反应发生率比较无明显差异(P>0.05)。结论亚麻醉剂量艾司氯胺酮预处理,能够明显减轻股骨骨折手术患者麻醉前摆放体位时的疼痛程度,缩短麻醉操作时间,提高患者麻醉满意度,且不导致不良反应发生率增高。Objective To investigate the analgesic effect of sub-anesthetic dose of esketamine pretreatment in patients underwent femoral fractures during the positioning phase before anesthesia.Methods From March 2021 to March 2024,60 patients undergoing elective surgery for femoral fracture reduction and internal fixation in Jieyang People's Hospital were enrolled as study subjects,and they were randomly divided into the observation group and the control group,with 30 cases in each group.The observation group received an intravenous injection of esketamine at a dose of 0.125mg/kg before the implementation of combined spinal-epidural anesthesia,while the control group received an equal amount of physiological saline.Both groups were positioned in the lateral decubitus position for combined spinal-epidural anesthesia 15 minutes after the injection.The visual analog scale(VAS)pain scores and Ramsay Sedation Scale scores were recorded for both groups at the time of entering the operating room,10 minutes after esketamine injection,during positioning,and after anesthesia.The operation time for combined spinal-epidural anesthesia,patient satisfaction with anesthesia,and the incidence of anesthesia-related adverse reactions during the perioperative period,mainly including nausea,vomiting,headache,hypotension,and delirium,were also recorded.Results The VAS pain scores of the observation group during positioning were significantly lower than those of the control group(P<0.05),however,with no significant differences in VAS pain scores at other time points between the two groups(P>0.05).The Ramsay Sedation Scale scores of the observation group during positioning and after anesthesia were significantly higher than those of the control group(P<0.05),while with no significant difference in Ramsay Sedation Scale scores at the time of entering the operating room between the two groups(P>0.05).The operation time for combined spinal-epidural anesthesia in the observation group was significantly shorter than that in the control group(P<0.05),

关 键 词：亚麻醉剂量 艾司氯胺酮 预处理 股骨骨折 摆放体位 镇痛 

分 类 号：R614[医药卫生—麻醉学]