摘要
目的观察诱导期使用小剂量艾司氯胺酮对老年胃肠道手术患者全麻诱导期血流动力学和术后谵妄的影响。方法选择全麻行胃肠道手术患者80例,年龄≥60岁,ASA分级Ⅰ或Ⅱ级,术前简易智能状态量表评分>23分。采用随机数字表法分为2组(n=40):艾司氯胺酮组和对照组。麻醉诱导前艾司氯胺酮组静脉注射艾司氯胺酮0.25mg/kg,对照组静脉注射等容量生理盐水。随后静脉注射咪达唑仑、依托咪酯、舒芬太尼和顺阿曲库铵诱导,静脉泵注丙泊酚、瑞芬太尼,间断注射顺阿曲库铵维持麻醉。比较两组入室5min后(T0)、插管前(T1)、插管后即刻(T2)、插管后3min(T3)的心率、平均动脉压,比较谵妄发生率、术后疼痛评分(NRS)和术后其他不良反应发生情况。结果两组T0时的心率、平均动脉压比较差异无统计学意义(P>0.05),两组T2时的心率及T3时的平均动脉压比较,差异有统计学意义(P<0.05)。艾司氯胺酮组的心率、平均动脉压在各时间点无明显变化(P>0.05)。对照组心率和平均动脉压在T1时较T0降低,T3时较T2时降低,T2时的心率较T1时升高(P<0.05)。艾司氯胺酮组有2例患者出现术后谵妄,低于对照组(8例)(P<0.05)。两组NRS评分和术后其他不良反应发生率差异均无统计学意义(P>0.05)。结论诱导期应用小剂量艾司氯胺酮可以减少老年手术患者麻醉诱导期血流动力学波动,降低术后谵妄的发生率。
Objective To observe the effects of low-dose esketamine on hemodynamics during anesthesia induction and postoperative delirium in elderly patients undergoing gastrointestinal surgery.Methods Eighty elderly patients,aged≥60 years undergoing elective gastrointestinal surgery,of American Society of Anesthesiologists status Ⅰ or Ⅱ,preoperative Mini Mental State Examination score>23,were divided into 2 groups(n=40each)using a random number table method:esketamine group and control group.In esketamine group,0.25mg/kg esketamine was intravenously injected before anesthesia induction,and the same volume of normal saline was intravenously injected in control group.Anesthesia was induced with intravenous injection of midazolam,etomidate,sufentanil and cisatracurium,maintained with intravenous infusion of propofol and remifentanil and intermittent intravenous injection boluses of cisatracurium.Heart rate,mean arterial pressure at 5 min after entering operation room(T0),before intubation(T1),immediately after intubation(T2),3min after intubation(T3)were compared between the two groups.Incidence of delirium,postoperative pain score,and incidence of other postoperative adverse reactions were compared between the two groups.Results There was no statistical difference in heart rate and blood pressure at T0 between the two groups(P>0.05),but there was statistical difference in heart rate at T2 and mean arterial pressure at T3 between the two groups(P<0.05).There was no statistical difference in heart rate and mean arterial pressure at T0,T1,T2 and T3 in esketamine group(P>0.05).The heart rate and mean arterial pressure in the control group were lower at T1 than at T0,lower at T3 than at T2,and the heart rate was higher at T2 than at T1(P<0.05).2 patients developed delirium in esketamine group(5%),8 patients in the control group(20%),the incidence of delirium was lower in the esketamine group(P<0.05),and there was no statistical difference in NRS score and incidence of other postoperative adverse reactions(P>0.05).Conclusion
作者
曹彬
何龙
赵颖莹
代辉
杨建军
CAO Bin;HE Long;ZHAO Ying-ying(Department of Anesthesiology and Perioperative Medicine,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中国实验诊断学》
2022年第9期1291-1294,共4页
Chinese Journal of Laboratory Diagnosis
