右美托咪定复合艾司氯胺酮用于老年脊柱手术患者的临床研究  

Clinical trial of dexmedetomidine combined with esketamine in elderly patients undergoing spinal surgery

作　　者：王亚群[1] 夏西尚 汪东学 王辉[1] 王玲[1] WANG Ya-qun;XIA Xi-shang;WANG Dong-xue;WANG Hui;WANG Ling(Department of Anesthesiology,Anqing First People's Hospital,Anqing 246003,Anhui Province,China;Spinal Surgery,Anqing First People's Hospital,Anqing 246003,Anhui Province,China)

机构地区：[1]安庆市第一人民医院麻醉科,安徽安庆246003 [2]安庆市第一人民医院脊柱外科,安徽安庆246003

出　　处：《中国临床药理学杂志》2024年第14期2013-2017,共5页The Chinese Journal of Clinical Pharmacology

摘　　要：目的观察右美托咪定注射液复合艾司氯胺酮注射液对接受脊柱手术的老年患者术后早期疼痛和认知功能的影响。方法将老年脊柱手术患者用随机数字表法分为对照组和试验组,2组患者均给予肌肉注射艾司氯胺酮3 mg·kg^(-1)进行麻醉诱导,对照组给予丙泊酚4 mg·kg^(-1)麻醉,静脉恒速泵注;试验组给予右美托咪定1μg·kg^(-1),静脉泵注10 min,随后以0.5μg·kg^(-1)速度持续泵注。观察2组患者术前5 min(T1)、手术开始5 min(T2)、结束手术时(T3)、苏醒时(T4)生命体征变化,术后早期疼痛情况和认知功能,首次静脉自控镇痛(PCA)时间及48 h内不同时间段舒芬太尼累积用量及药物不良反应发生情况。结果对照组和试验组分别纳入44和45例患者。T2、T3、T4时,试验组的心率分别为(82.51±3.05)、(80.15±3.21)和(81.51±3.04)beat·min^(-1),对照组的心率分别为(92.54±3.10)、(93.52±3.05)和(88.45±3.51)beat·min^(-1),试验组的平均动脉压(MAP)分别为(54.51±3.58)、(55.25±3.21)和(60.25±3.24)mmHg,对照组的MAP分别为(73.25±3.54)、(70.52±3.20)和(68.51±3.05)mmHg,试验组的血氧饱和度(SPO2)分别为(98.56±0.38)%、(98.25±0.35)%、(99.02±0.14)%,对照组的SPO2分别为(94.52±0.35)、(95.25±0.25)、(96.25±0.32)%;术后2、4、6和8 h,试验组的视觉模拟疼痛(VAS)评分分别为(5.69±1.12)、(5.02±0.89)、(4.52±0.65)和(4.01±0.45)分,对照组的分别为(6.25±1.35)、(5.46±1.12)、(4.98±0.84)和(4.25±0.52)分;术后24、36和72 h,试验组的简易智力状态检测量表(MMSE)评分分别为(24.25±1.15)、(26.25±1.14)、(27.25±0.89)、(28.86±0.62)分,对照组分别为(22.52±1.02)、(24.25±1.12)、(26.58±0.87)和(28.78±0.52)分,试验组的上述指标与对照组比较,在统计学上差异均有统计学意义(均P<0.05)。对照组的药物不良反应主要有嗜睡、呼吸抑制、恶心呕吐,试验组药物不良反应主要有嗜睡、恶心呕吐,试验组和对照组总药物不良反应Objective To observe the effects of dexmedetomidine combined with esketamine on early postoperative pain and cognitive function in elderly patients undergoing spinal surgery.Methods The aged spinal surgery patients were divided into control group and treatment group by random number table method.Both groups were anesthetically induced by intramuscular injection of esketamine 3 mg·kg^(-1),while the control group was anesthetically induced by intravenous injection of propofol 4 mg·kg^(-1)with constant velocity pump.The treatment group was given 1μg·kg^(-1)dexmedetomidine by intravenous pump for10 min,and then continued pumping at 0.5μg·kg^(-1)rate.The changes of vital signs 5 min before surgery(T1),5 min after surgery(T2),at the end of surgery(T3),at the time of recovery(T4),early postoperative pain,cognitive function,the time of the first patient control analgesia(PCA),the cumulative dosage of sufentanil in different time periods within 48 h and the occurrence of adverse drug reactions were observed in the 2 groups.Results 44patients were included in the control group and 45 patients in the treatment group,respectively.At T2,T3 and T4,the heart rate of treatment group were(82.51±3.05),(80.15±3.21)and(81.51±3.04)beat·min^(-1),and that of control group were(92.54±3.10),(93.52±3.05)and(88.45±3.51)beat·min^(-1),respectively.The mean arterial pressure(MAP)of the treatment group were(54.51±3.58),(55.25±3.21)and(60.25±3.24)mm Hg;and that of the control group were(73.25±3.54),(70.52±3.20)and(68.51±3.05)mm Hg,respectively.The blood oxygen saturation(SPO_(2))of treatment groups were(98.56±0.38)%,(98.25±0.35)%and(99.02±0.14)%;and the SPO_(2) of control group were(94.52±0.35)%,(95.25±0.25)%and(96.25±0.32)%,respectively.Visual analogue pain(VAS)scores were(5.69±1.12),(5.02±0.89),(4.52±0.65)and(4.01±0.45)scores at 2,4,6 and 8 h after operation,respectively;the control group were(6.25±1.35),(5.46±1.12),(4.98±0.84)and(4.25±0.52)scores,respectively.24,36 and 72 h after operation,the scores of MMSE

关 键 词：盐酸右美托咪定注射液 盐酸艾司氯胺酮注射液 丙泊酚乳状注射液 脊柱手术 疼痛 认知功能 

分 类 号：R971.2[医药卫生—药品]