亚麻醉剂量艾司氯胺酮对老年患者无痛纤支镜中血流动力学的影响

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摘要 目的：探讨亚麻醉剂量艾司氯胺酮对老年患者无痛纤支镜中血流动力学的影响。方法：选取2021年11月―2022年5月在我院进行无痛纤支镜检查的老年患者100例,采用随机数字表法分为对照组和试验组。试验组先给予0.15 mg/kg盐酸艾司氯胺酮静推,对照组则先给予等容积的生理盐水静推,随后两组患者均再给予丙泊酚与瑞芬太尼靶控输注（TCI）进行麻醉诱导与维持,待患者意识消失,脑电双频指数（BIS）值<60时置入喉罩并连接麻醉机进行机械通气,术中维持BIS值40~60。观察两组患者不同时间点血流动力学的变化及术中丙泊酚和瑞芬太尼时间标准化用量、不良反应发生率、血管活性药物的使用率、麻醉时间及术后苏醒指标监测评分的差异。结果：两组在插喉罩前（T1）、检查中（T2）、苏醒时（T3）收缩压（SBP）、舒张压（DBP）较麻醉诱导前（T0）均降低;试验组在T1、T2、T3时刻SBP和DBP较对照组同时刻均增加;对照组在T1、T2时刻的HR均低于T0时刻,试验组T1时刻的HR低于T0,T2时刻的HR略高于T0时刻,至苏醒期,两组的HR均高于T0时刻;两组在T1、T2、T3时刻SpO2较T0时刻均增加;两组患者同一时刻HR和SpO2相比无差异。结论：亚麻醉剂量艾司氯胺酮应用于老年患者无痛纤支镜的检查对患者血流动力学影响小,安全性高,值得推广应用。

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	江秀芳
	柏璐
	许伟
	易虎
	罗柳
	熊强强
	毛鑫城
	郑铭陟
	柒铭铭

关键词 ：艾司氯胺酮, 老年患者, 无痛纤支镜

Abstract：Objective To investigate the effect of flax intoxication dose of Ketamine on hemodynamics in painless fiberoptic bronchoscopy in geriatric patients. Methods A total of 100 geriatric patients undergoing painless bronchoscopy from November 2021 to May 2022 were selected and randomly divided into control group and experimental group. The experimental group was given intravenous injection of 0.15 mg/kg esmketamine hydrochloride, while the control group was given intravenous injection of equal volume of normal saline, and then the patients in both groups were given TCI pump injection of propofol and remifentanil for anesthesia induction and maintenance. When the patient's consciousness disappeared and the BIS value was less than 60, the laryngeal mask was placed and connected to the anesthesia machine for mechanical ventilation, and the BIS value was maintained at 40~60 during operation. The hemodynamic changes at different time points, the time standardized dosage of propofol and remifentanil, the incidence of adverse reactions, the use rate of vasoactive drugs, anesthesia time and postoperative recovery index monitoring scores of the two groups were observed. Results SBP and DBP in the two groups before laryngeal mask insertion (T1), during examination (T2), and at awakening (T3) were lower than those before induction of anesthesia (T0); The SBP and DBP of the experimental group at T1, T2 and T3 were higher than those of the control group at the same time. The HR of the control group at T1 and T2 was lower than that at T0; the HR of the experimental group at T1 was lower than that at T0, and the HR of the experimental group at T2 was slightly higher than that at T0. To the recovery period, the HR of the two groups was higher than that at T0; Compared with T0, SpO2 at T1, T2 and T3 increased in both groups; There was no difference in HR and SpO2 between the two groups at the same time. Conclusion Anesthesia dose of esmketamine used in geriatric patients with painless fiberoptic bronchoscopy has little impact on hemodynamics and high safety, which is worthy of promotion and application.

Key words： esketamine geriatric patients painless bronchoscopy

收稿日期: 2023-02-26

中图分类号:

R614

基金资助:湖南省医学会医学科研基金（HNA202101013）

通讯作者: 郑铭陟,E-mail：547135294@qq.com

引用本文:

江秀芳, 柏璐, 许伟, 易虎, 罗柳, 熊强强, 毛鑫城, 郑铭陟, 柒铭铭. 亚麻醉剂量艾司氯胺酮对老年患者无痛纤支镜中血流动力学的影响[J]. 湖南师范大学学报(医学版), 2023, 20(3): 61-65. JIANG Xiufang, BAI Lu, XU Wei, YI Hu, LUO Liu, XIONG Qiangqiang, MAO Xincheng, ZHENG Mingzhi, QI Mingming. The clinical application of subanesthetic dose of esketamine in geriatric patients with painless bronchoscopy. HuNan ShiFan DaXue XueBao(YiXueBan), 2023, 20(3): 61-65.

链接本文:

http://yxb.hunnu.edu.cn/CN/ 或 http://yxb.hunnu.edu.cn/CN/Y2023/V20/I3/61

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