低剂量艾司氯胺酮对支撑喉镜手术患者拔管期呛咳反应的影响  

Effect of low-dose s-ketamine on cough response during extubation period in patients undergoing suspension laryngoscopic surgery

作　　者：施东婧 包音[1] 裴春明[1] 梁轩[1] 奚春花[1] 王古岩 Shi Dongjing;Bao Yin;Pei Chunming;Liang Xuan;Xi Chunhua;Wang Guyan(Department of Anesthesiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,北京100730

出　　处：《中华医学杂志》2025年第8期611-616,共6页National Medical Journal of China

基　　金：北京市医院管理中心“登峰”计划(DFL20220203)。

摘　　要：目的探讨低剂量艾司氯胺酮对支撑喉镜手术患者拔管期呛咳反应的影响。方法前瞻性纳入2023年11月至2024年1月于首都医科大学附属北京同仁医院择期行支撑喉镜手术的患者66例,男41例,女25例,年龄(49.6±11.1)岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级。采用随机数字表法分为试验组和对照组,每组33例;试验组在麻醉诱导后静脉注射0.25 mg/kg艾司氯胺酮,对照组给予等体积生理盐水。主要观察指标为拔管时呛咳和中重度呛咳反应发生率,次要观察指标为入手术室时(T0)、插管前(T1)、插管后1 min(T2)、置入支撑喉镜后1 min(T3)、置入支撑喉镜后5 min(T4)、手术结束时(T5)、拔管时(T6)的心率和平均动脉压以及拔管时间、出入恢复室改良Aldrete评分、恢复室停留时间、出恢复室和术后6 h疼痛数字评定量表(NRS)评分和不良反应。结果两组年龄、性别、ASA分级、体质指数及手术时间差异均无统计学意义(均P>0.05),试验组拔管时呛咳反应发生率和中重度呛咳反应发生率分别为39.4%(13/33)和12.1%(4/33),均低于对照组[分别为66.7%(22/33)和36.4%(12/33)](均P<0.05)。两组各时间点的心率和平均动脉压差异均无统计学意义(均P>0.05)。两组拔管时间、出入恢复室改良Aldrete评分、恢复室停留时间、出恢复室和术后6 h疼痛NRS评分差异均无统计学意义(均P>0.05)。两组均未出现分泌物增多、喉痉挛、躁动、噩梦、幻觉、视物模糊、头痛等不良反应。结论低剂量艾司氯胺酮能有效降低支撑喉镜手术患者术后拔管期呛咳反应发生率和严重程度,并且对术中循环、术后苏醒以及不良反应的发生无明显影响。Objective To evaluate the effect of low-dose s-ketamine on cough response during extubation period in patients undergoing suspension laryngoscopic surgery.Methods From November 2023 to January 2024,66 adult patients(41 males and 25 females)scheduled for suspension laryngoscopic surgery in Beijing Tongren Hospital Affiliated to Capital Medical University were enrolled,with age of(49.6±11.1)years and American Society of Anesthesiologists(ASA)gradeⅠ-Ⅱ.The patients were divided into two groups using a random number table method:treatment group(n=33)and control group(n=33).Patients in the treatment group received 0.25 mg/kg s-ketamine intravenously after induction,and the control group received the same volume of normal saline.The main outcomes included the incidence of cough response and moderate to severe cough response during extubation.The secondary outcomes included heart rate and mean arterial pressure(MAP)at the time of entering the operation room(T0),before intubation(T1),1 min after intubation(T2),1 min after suspending laryngoscope(T3),5 min after suspending laryngoscope(T4),at the end of surgery(T5),and immediately after intubation(T6).Extubation time,the modified Aldrete scores on entering and exiting post-anesthesia care unit(PACU),length of stay in PACU,the numerical rating scale(NRS)scores on exiting PACU and 6 h after surgery and adverse events were also recorded.Results There were no significant differences in age,gender,ASA grade,body mass index and operation time between the two groups(P>0.05).The incidence of cough response and moderate to severe cough response in the treatment group was 39.4%(13/33)and 12.1%(4/33),respectively.They were significantly lower than those in the control group[66.7%(22/33),36.4%(12/33)](all P<0.05).There was no significant difference in the changes of heart rate and MAP between the two groups at any time point(P>0.05).There were no significant differences in extubation time,the modified Aldrete scores on entering and exiting PACU,length of stay in PACU and NRS scor

关 键 词：喉镜 艾司氯胺酮 支撑喉镜手术 呛咳 

分 类 号：R614[医药卫生—麻醉学]