艾司氯胺酮复合右美托咪定在无阿片喉罩全身麻醉的输尿管钬激光碎石术中的应用  

Application of esketamine combined with dexmedetomidine in ureteroscopic holmium laser lithotripsy under non-opioid general anesthesia with laryngeal mask airway

作　　者：毛姗姗 冯秀梅 胡蕊 黄群 MAO Shanshan;FENG Xiumei;HU Rui;HUANG Qun(Department of Anesthesiology,Xuzhou City Hospital of Traditional Chinese Medicine,Xuzhou 221000,Jiangsu,China)

机构地区：[1]江苏省徐州市中医院麻醉科,江苏徐州221000

出　　处：《外科研究与新技术（中英文）》2024年第3期231-235,共5页Surgical Research and New Technique

摘　　要：目的研究全身麻醉喉罩置入的输尿管结石钬激光软镜碎石手术中去阿片化麻醉的可行性。方法选择2022年8月—2023年2月在徐州市中医院行输尿管结石手术的60例患者作为研究对象。按随机数字表法将患者分为观察组和对照组,每组各30例。麻醉诱导前10 min,两组均给予右美托咪定0.4μg(/kg·h)匀速泵注;麻醉诱导阶段,观察组予以艾司氯胺酮0.3 mg/kg,对照组予以芬太尼;麻醉维持阶段,观察组予以氯胺酮0.1 mg/kg联合丙泊酚泵注,对照组予以瑞芬太尼联合丙泊酚泵注。观察比较两组在麻醉诱导前10 min(T0)、意识消失时(T1)、喉罩置入即刻(T2)、手术开始时(T3)、手术结束时(T4)、拔出喉罩即刻(T5)的平均动脉压(MAP)、心率(heart rate,HR)变化情况。比较两组丙泊酚及术中血管活性药物的使用情况,术后自主呼吸恢复时长、喉罩拔除时间、恶心呕吐例数、术后30 min视觉模拟评分法(VAS)评分、术后4 h内追加使用非甾体类抗炎药(NSAIDs)的例数。结果T1时间点观察组的MAP和HR均高于对照组,差异有统计学意义(P<0.05),其余时间点差异无统计学意义(P>0.05)。观察组麻醉维持期丙泊酚使用量少于对照组,差异有统计学意义(P<0.05)。术中血管活性药物使用例数少于对照组,差异无统计学意义(P>0.05)。两组患者自主呼吸恢复时长、喉罩拔除时间比较,差异均无统计学意义(P>0.05)。观察组3例患者术后发生恶心、呕吐,对照组5例发生恶心、呕吐,组间差异无统计学意义(P>0.05)。观察组术后30 min静息VAS评分低于对照组,差异有统计学意义(P<0.05)。术后4 h观察组3例患者口服镇痛药,对照组5例患者口服镇痛药,组间差异无统计学意义(P>0.05)。结论艾司氯胺酮复合右美托咪定及NSAIDs药物使全身麻醉喉罩置入的输尿管钬激光碎石手术可以不使用阿片类药物。Objective To study the feasibility of not using opioids in ureteroscopic holmium laser lithotripsy under general anesthesia with laryngeal mask airway.Methods Patients with elective lithotripsy who were diagnosed and treated in Xuzhou City Hospital of Traditional Chinese Medicine between August 2022 and February 2023 were enrolled as study subjects and randomly divided into an experimental group of 30 cases and a control group of 30 cases.Both groups were given 0.4μg(/kg·h)dexmedetomidine pump 10 min before anesthesia induction.The experimental group was given 0.3 mg/kg esketamine,and the control group was given fentanyl during anesthesia induction.The experimental group was given 0.1 mg/kg ketamine combined with propofol pump,and the control group was given remifentanil combined with propofol pump during anesthesia maintenance.The mean arterial pressure(MAP)and heart rate(HR)were compared between the two groups at 10 min before anesthesia induction(T0),at the time of loss of consciousness(T1),immediately after insertion of laryngeal mask airway(T2),at the beginning of the surgery(T3),at the end of the surgery(T4),and at the time of extraction of laryngeal mask airway(T5).The dosage of propofol and the use of intraoperative vasoactive drugs were recorded.The recovery time of spontaneous breathing,laryngeal mask airway removal time,postoperative nausea and vomiting,postoperative 30 min visual analogue scale(VAS)score,and the number of cases who required additional nonsteroidal anti-inflammatory drugs(NSAIDs)at postoperative 4 h were also compared between the two groups.Results At T1,the MAP and HR in the experimental group were higher than those in the control group(P<0.05),and there was no significant difference at other time points(P>0.05).The dosage of propofol in the experimental group was significantly less than that in the control group during anethesia maintenance(P<0.05).The cases who used intraoperative vasoactive drugs in the experimental group was less than the cases in the control group,but no statis

关 键 词：艾司氯胺酮 右美托咪定 无阿片类镇痛药 输尿管钬激光碎石 

分 类 号：R614.4[医药卫生—麻醉学]