艾斯氯胺酮预防性用药对老年手术患者麻醉效果与术后谵妄的影响  

The Impact of Prophylactic Administration of Eschloramine Ketamine on Anesthetic Effects and Postoperative Delirium in Elderly Surgical Patients

作　　者：韩亚鹏 张辉然 鲁慧利 HAN Yapeng;ZHANG Huiran;LU Huili(Anesthesia Department,First People's Hospital of Ruzhou,Ruzhou Henan 467500,China)

机构地区：[1]汝州市第一人民医院手术室麻醉科,河南汝州467500

出　　处：《临床研究》2025年第4期54-57,共4页Clinical Research

摘　　要：目的研究在老年患者手术前使用不同剂量艾斯氯胺酮作为预防性药物对麻醉效果及术后谵妄的预防作用。方法选取2021年1月至2023年12月间,在汝州市第一人民医院接受全身麻醉的120名老年患者作为研究对象进行前瞻性的研究。通过随机数字法把120名患者平均分配到观察组和对照组,每组各60名患者。在麻醉诱导期间,对照组接受0.5 mg/kg艾司氯胺酮,而观察组则接受0.3 mg/kg艾司氯胺酮。分析两组患者在四个关键时间节点[术前准备(T_(0))、气管插管即将进行(T_(1))、气管插管作业完毕(T_(2))、气管插管后即刻(T_(3))]的心血管状态及应激水平变化,同时记录术后谵妄与并发症的出现概率。结果两组老年患者在各个时间节点的收缩压、舒张压及心率指标对比,无统计学意义(P>0.05)。在T_(0)与T_(3)时刻,两组患者的肾上腺素及去甲肾上腺素水平亦无统计学意义(P>0.05)。观察组患者在手术后出现谵妄的情况显著少于对照组(P<0.05)。两组患者术后不良事件的总发生率比较,无统计学意义(P>0.05)。结论不论是采用0.3 mg/kg还是0.5 mg/kg的艾司氯胺酮进行老年患者全身麻醉的诱导,都能保持血流动力学的稳定,并能有效减轻由气管插管引发的应激反应,避免低血压和心动过缓等副作用。关键是在使用0.3 mg/kg艾司氯胺酮剂量,能进一步减少患者术后谵妄的发生。Objective To study the effects of different doses of eschloramine ketamine used prophylactically before surgery in elderly patients on anesthetic effects and the prevention of postoperative delirium.Methods A prospective study was conducted with 120 elderly patients who underwent general anesthesia at the First People's Hospital of Ruzhou from January 2021 to December 2023.The patients were randomly assigned to the observation group and the control group,with 60 patients in each group.During anesthesia induction,the control group received 0.5 mg/kg of eschloramine ketamine,while the observation group received 0.3 mg/kg.Changes in cardiovascular status and stress levels at four key time points(preoperative preparation(T_(0)),just before intubation(T_(1)),completion of intubation(T_(2)),and immediately after intubation(T_(3)))were analyzed,along with the incidence of postoperative delirium and complications.Results There were no statistically significant differences in systolic blood pressure,diastolic blood pressure,or heart rate between the two groups at each time point(P>0.05).At T_(0) and T_(3),levels of epinephrine and norepinephrine showed no statistical significance between the two groups(P>0.05).The incidence of postoperative delirium was significantly lower in the observation group than in the control group(P<0.05).There was no significant difference in the total incidence of adverse events after surgery between the two groups(P>0.05).Conclusion Both 0.3 mg/kg and 0.5 mg/kg doses of eschloramine ketamine can maintain hemodynamic stability during the induction of general anesthesia in elderly patients while effectively reducing stress responses induced by intubation,thereby avoiding side effects such as hypotension and bradycardia.Notably,the use of 0.3 mg/kg eschloramine ketamine can further reduce the occurrence of postoperative delirium in patients.

关 键 词：艾斯氯胺酮 麻醉效果 术后谵妄 血流动力学指标 应激反应 

分 类 号：R614[医药卫生—麻醉学]