摘要
目的研讨老年胃肠道手术患者使用小剂量艾司氯胺酮对麻醉诱导期血流动力学及术后谵妄的影响。方法随机选取2020年5月—2023年5月三明市第二医院行胃肠道手术的80例老年患者为研究对象,按随机数表法分组,观察组40例麻醉诱导前予以0.25 mg/kg艾司氯胺酮静注,对照组40例予以等量生理盐水静注,全凭静脉麻醉采用丙泊酚、瑞芬太尼静脉泵注以及顺式阿曲库铵间断注射。比较两组不同时间点的血流动力学、疼痛状况、术后谵妄及其他不良反应发生情况。结果观察组T2时点的心率(heart rate,HR)(72.69±8.35)次/min低于对照组(79.94±10.07)次/min,T1、T3时点的平均动脉压(mean arterial pressure,MAP)(95.92±8.47)mmHg和(95.82±9.54)mmHg高于对照组(90.16±10.85)、(84.26±9.37)mmHg,差异有统计学意义(t=3.505、2.646、5.467,P<0.05)。两组术后第1、2、3天的疼痛数字评分法(numerical rating scale,NRS)得分对比,差异无统计学意义(P>0.05)。观察组术后谵妄发生率低于对照组,差异有统计学意义(P<0.05)。两组患者不良反应(恶心、呕吐及尿管刺激)发生占比对比,差异无统计学意义(P>0.05)。结论辅用小剂量艾司氯胺酮能够更好地稳定老年胃肠道手术患者诱导期的血流动力学,并且对减少术后谵妄的发生有一定作用。
Objective To examine the effect of low-dose esketamine on hemodynamics during induction of anesthesia and postoperative delirium in elderly patients undergoing gastrointestinal surgery.Methods A total of 80 elderly patients who underwent gastrointestinal surgery in Sanming Second Hospital from May 2020 to May 2023 were randomly selected as the research objects.The patients were grouped according to the random number table method.40 patients in the observation group were given 0.25 mg/kg esketamine intravenous injection before anesthesia induction,and 40 patients in the control group were given the same amount of normal saline intravenous injection.Total intravenous anesthesia was performed with propofol,remifentanil intravenous pump injection and intermittent injection of cis atracurium.Hemodynamics,pain status,postoperative delirium and other adverse reactions were compared between the two groups at different time points.Results The heart rate(HR)of the observation group at T2(72.69±8.35)times/min was lower than that of the control group(79.94±10.07)times/min,and the mean arterial pressure(MAP)at T1 and T3(95.92±8.47)mmHg and(95.82±9.54)mmHg were higher than those of the control group(90.16±10.85)mmHg and(84.26±9.37)mmHg,the difference was statistically significant(t=3.505,2.646,5.467,P<0.05).There was no significant difference in Numerical Rating Scale(NRS)scores between the two groups on the 1 st,2 nd and 3 rd day after operation(P>0.05).The incidence of postoperative delirium in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).There was no significant difference in the proportion of adverse reactions(nausea,vomiting and urinary catheter stimulation)between the two groups(P>0.05).Conclusion Adjunctive low-dose esketamine better stabilizes hemodynamics during the induction period in elderly patients undergoing gastrointestinal surgery and has been shown to reduce the incidence of postoperative delirium.
作者
李育蓉
施小红
LI Yurong;SHI Xiaohong(Department of Anesthesiology,Sanming Second Hospital,Sanming,Fujian Province,366000 China)
出处
《中外医疗》
2023年第23期80-83,共4页
China & Foreign Medical Treatment
关键词
胃肠道手术
艾司氯胺酮
血流动力学
术后谵妄
Gastrointestinal surgery
Esketamine
Hemodynamics
Postoperative delirium
