艾司氯胺酮复合丙泊酚在老年患者腹腔镜胆囊手术全麻诱导中的应用  

Application of Esketamine Combined with Propofol in Induction of General Anesthesia in Laparoscopic Cholecystectomy in Elderly Patients

作　　者：杜治昆 司小萌[2] 司海超[2] 王卓 DU Zhi-kun;SI Xiao-meng;SI Hai-chao;WANG Zhuo(Department of Emergency Trauma Surgery,Nanyang Central Hospital,Nanyang 473000,China;DepartmentⅠof Surgery,Nanyang Central Hospital,Nanyang 473000,China;Department of Western Medicine,Nanyang Central Hospital,Nanyang 473000,China)

机构地区：[1]南阳市中心医院急诊创伤外科手术室,南阳473000 [2]南阳市中心医院手术一部,南阳473000 [3]南阳市中心医院西药药学部,南阳473000

出　　处：《中国合理用药探索》2025年第3期99-105,共7页Chinese Journal of Rational Drug Use

摘　　要：目的:探讨艾司氯胺酮复合丙泊酚在老年患者腹腔镜胆囊手术全麻诱导中的应用价值。方法:选取2022年1月~2024年1月期间于某院接受腹腔镜胆囊手术的90例老年患者作为研究对象,采用信封法单盲分为对照组和观察组,每组45例。对照组患者给予枸橼酸舒芬太尼注射液复合丙泊酚乳状注射液麻醉,观察组患者给予盐酸艾司氯胺酮注射液复合丙泊酚乳状注射液麻醉。比较两组患者临床指标(患者自主呼吸恢复时间、睁眼时间、拔管时间)、不同时间段[麻醉前(T_(0))、插管时(T_(1))、术毕(T_(2))和术后5 min(T_(3))]心率(HR)、收缩压(SBP)、舒张压(DBP)和血氧饱和度(SpO_(2))、简易智力状态检查量表(MMSE)评分、视觉模拟评分(VAS)、应激指标[皮质醇(Cor)和肾上腺素(E)]及不良反应发生情况。结果:观察组患者自主呼吸恢复时间、睁眼时间、拔管时间均早于对照组(P<0.05)。两组患者T_(1)、T_(2)和T_(3)时HR、DBP、SBP较T_(0)时均升高(P<0.05),且观察组低于对照组(P<0.05);不同时间段Sp O_(2)比较无统计学差异(P>0.05);术前、术后6 h MMSE评分比较均无统计学差异(P>0.05);术后1 h、6 h和12 h疼痛VAS评分比较均无统计学差异(P>0.05);术后6 h,血清Cor和E水平均升高(P<0.05),但观察组低于对照组(P<0.05)。观察组患者不良反应总发生率(6.67%)低于对照组(24.44%,P<0.05)。结论:艾司氯胺酮复合丙泊酚在老年患者腹腔镜胆囊手术全麻诱导中具有较好的应用价值,有助于稳定血流动力学,减轻应激反应,缩短患者苏醒时间,且能减少不良反应的发生。Objective:To investigate the application value of esketamine combined with propofol in the induction of general anesthesia in elderly patients undergoing laparoscopic cholecystectomy.Methods:A total of 90 elderly patients undergoing laparoscopic cholecystectomy during January 2022 to January 2024 in a hospital were selected and divided into the control group and the observation group by envelope method and single-blinded method,with 45 patients in each group.The control group was given sufentanil citrate injection combined with propofol injectable emulsion for anesthesia,and the observation group was given esketamine hydrochloride injection combined with propofol injectable emulsion for anesthesia.The clinical indexes(recovery time of spontaneous respiration,eye opening time,extubation time),heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),blood oxygen saturation(SpO_(2))at different time points[before anesthesia(T_(0)),at intubation(T_(1)),at the end of surgery(T_(2))and 5 minutes after surgery(T_(3))],mini-mental state examination(MMSE)score,visual analogue scale(VAS),stress indexes[cortisol(Cor)and epinephrine(E)]and adverse reactions were compared between the two groups.Results:The recovery time of spontaneous respiration,eye opening time and extubation time in the observation group were earlier than those in the control group(P<0.05).HR,DBP and SBP at T_(1),T_(2) and T_(3) in both groups were higher than those at T_(0)(P<0.05),while lower in the observation group than in the control group(P<0.05).There was no statistically significant difference in SpO_(2) between the two groups at different time points(P>0.05).There was no statistically significant difference in MMSE score between the two groups before treatment and 6 hours after operation(P>0.05).There was no statistically significant difference in pain VAS score between the two groups at 1h,6h and 12h after operation(P>0.05).At 6h after operation,the serum levels of Cor and E were increased in both groups(P<0.05),while lower in th

关 键 词：艾司氯胺酮 丙泊酚 老年患者 腹腔镜胆囊手术 全麻 

分 类 号：R614[医药卫生—麻醉学]