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投稿时间:2024-01-30 网络发布日期:2024-08-20
投稿时间:2024-01-30 网络发布日期:2024-08-20
中文摘要: 目的 分析亚麻醉剂量艾司氯胺酮对全麻腰椎手术患者围术期血流动力学及不良反应的影响。方法 回顾性分析2021年6月至2023年6月在南京大学医学院附属金陵医院行全麻腰椎手术治疗患者70例的临床资料。根据麻醉诱导方式分为常规组(常规静脉麻醉诱导,n=35)、艾司氯胺酮组(亚麻醉剂量艾司氯胺酮+常规静脉麻醉诱导,n=35),比较两组患者在麻醉诱导前(T0)、术前即刻(T1)、手术结束时(T2)、术后苏醒时(T3)的血流动力学指标[心率(HR)、平均动脉压(MAP)]、血液中去甲肾上腺素(NE)水平,比较两组患者血管活性药物用量(阿托品、去氧肾上腺素)、不良反应(恶心呕吐、术后躁动、呼吸抑制、心动过缓)发生情况。结果 常规组患者T1、T2点时HR水平低于T0时点,T3点时HR水平高于T1、T2时点,T2时点,艾司氯胺酮组患者HR水平高于常规组(P<0.05),艾司氯胺酮组患者各时点HR水平差异无统计学意义(P>0.05)。艾司氯胺酮组患者T1、T2、T3时点MAP水平低于T0时点,T1、T2时点,艾司氯胺酮组患者MAP水平高于常规组,常规组患者MAP水平随时间先下降后升高(P<0.05)。两组患者NE水平各时点均呈下降趋势,其中T1、T2、T3时点,艾司氯胺酮组患者NE水平高于常规组(P<0.05)。艾司氯胺酮组患者阿托品、去氧肾上腺素补救药物用量低于常规组(P<0.05)。艾司氯胺酮组患者心动过缓发生率低于常规组(5.71% vs 22.86%, χ2=4.200,P=0.040)。结论 亚麻醉剂量艾司氯胺酮可稳定全麻腰椎手术患者围术期血流动力学变化,麻醉效果好,减少血管活性药物用量,降低心动过缓发生情况,安全性较高。
中文关键词: 艾司氯胺酮,亚麻醉剂量 全身麻醉 腰椎手术 围术期 血流动力学
Abstract:Objective To analyze the effect of subanesthetic dose of esketamine on perioperative hemodynamics and adverse events in patients undergoing lumbar spine surgery under general anesthesia. Methods The clinical data of 70 patients who underwent general anesthesia lumbar spine surgery and treatment from June 2021 to June 2023 at Nanjing Jinling Hospital, Affiliated Hospital of Nanjing University Medical School, were retrospectively analyzed. According to the way of anesthesia induction, they were divided into the conventional group (conventional intravenous anesthesia induction, n=35) and the esketamine group (subanesthetic dose of esketamine+conventional intravenous anesthesia induction, n=35). Hemodynamic indices [heart rate (HR), mean arterial pressure (MAP)], and blood norepinephrine (NE) levels at each time point before induction of anesthesia (T0), in the immediate preoperative period (T1), at the end of the operation (T2), and at the time of postoperative awakening (T3), as well as the dosage of vasoactive medications (atropine and phenylephrine), and the incidence of adverse events (nausea and vomiting, postoperative agitation, respiratory depression, and bradycardia) were compared between the two groups. Results The HR levels of patients in the conventional group were significantly lower at T1 and T2 than that at T0, and significantly higher at point T3 than that at T1 and T2; at T2, the HR in the esketamine group was significantly higher than that in the conventional group (P<0.05), and the difference in HR levels of patients in the esketamine group at each time point was not statistically significant (P>0.05). The MAP levels of patients in the esketamine group at T1, T2 and T3 were significantly lower than those at T0, and the MAP levels of patients in the esketamine group were significantly higher than those in the conventional group at T1 and T2, and the MAP levels of patients in the conventional group first decreased and then increased over time, and the difference between the two groups was statistically significant (P<0.05). The NE levels of patients in both groups showed a decreasing trend at all time points, in which the NE levels of patients in the esketamine group were significantly higher than those in the conventional group at T1, T2 and T3 (P<0.05). The dosage of atropine and phenylephrine remedial drugs in patients in the esketamine group was significantly lower than that in the conventional group (P<0.05). The incidence of bradycardia in the esketamine group was significantly lower than that in the conventional group (5.71% vs 22.86%, χ2=4.200, P=0.040). Conclusion The subanesthetic dose of esketamine can stabilize the hemodynamic changes during surgery in patients undergoing lumbar spine surgery under general anesthesia, with a good anesthetic effect, reduce the dosage of anesthetic remedial drugs, reduce the incidence of bradycardia, and with a high degree of safety.
keywords: Esketamine,subanesthetic dose General anesthesia Lumbar spine surgery Perioperation Hemodynamics
文章编号: 中图分类号:R614 文献标志码:A
基金项目:
作者 | 单位 |
胡丹丹 | 1. 南京大学医学院附属金陵医院麻醉科,江苏 南京 210000; |
丁颖 | 2. 淮安八二医院,江苏 淮安 223000; |
陈捷 | 2. 淮安八二医院,江苏 淮安 223000; |
张利东 | 1. 南京大学医学院附属金陵医院麻醉科,江苏 南京 210000 |
引用文本:
胡丹丹,丁颖,陈捷,等.亚麻醉剂量艾司氯胺酮对全麻腰椎手术患者围术期血流动力学的影响[J].中国临床研究,2024,37(8):1183-1186,1219.
胡丹丹,丁颖,陈捷,等.亚麻醉剂量艾司氯胺酮对全麻腰椎手术患者围术期血流动力学的影响[J].中国临床研究,2024,37(8):1183-1186,1219.