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。
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.
关键词
艾司氯胺酮 /
老年患者 /
无痛纤支镜
Key words
esketamine /
geriatric patients /
painless bronchoscopy
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 邓小明, 王月兰, 冯艺, 等. (支) 气管镜诊疗镇静/麻醉专家共识 (2020版)[J]. 国际麻醉学与复苏杂志, 2021, 42(8) : 785-794.
[2] You AH, Kim JY, Kim DH, et al.Effect of remifentanil and midazolam on ED95 of propofol for loss of consciousness in elderly patients: A randomized, clinical trial[J]. Medicine (Baltimore) , 2019, 98(16) : e15132.
[3] Yoon H I, Kim J H, Lee J H, et al.Comparison of propofol and the combination of propofol and alfentanil during bronchoscopy: a randomized study[J]. Acta Anaesthesiol Scand, 2011, 55(1) : 104-109.
[4] 刘丹丹, 周巧云, 孙洪岩, 等. 无痛气管镜检查的安全性及舒适性研究[J]. 临床肺科杂志, 2017, 22(2) : 301-303.
[5] 丁钦, 解成兰, 岳苏阳, 等. 艾司氯胺酮临床应用研究进展[J]. 实用药物与临床, 2022, 25(08) : 754-758.
[6] 覃思平, 黄红梅, 林美情, 等. 艾司氯胺酮对剖宫产产妇应激反应与产后抑郁的影响[J]. 中国医师杂志, 2022, 24(06) : 936-938.
[7] Trimmel H, Helbok R, Staudinger T, et al.S (+) -ketamine: Current trends in emergency and intensive care medicine[J]. Wien Klin Wochenschr, 2018, 130(9-10) : 356-366.
[8] Nielsen RV, Fomsgaard JS, Nikolajsen L, et al.Intraoperative S-ketamine for the reduction of opioid consumption and pain one year after spine surgery: A randomized clinical trial of opioid-dependent patients[J]. Eur J Pain, 2019, 23(3) : 455-460.
[9] 王莹莹, 赵璇. 右旋氯胺酮药理机制和药物动力学特点及临床应用的研究进展[J]. 中华实用诊断与治疗杂志, 2019, 33(7) : 724-728.
[10] Eberl S, Koers L, van Hooft J, et al. The effectiveness of a low-dose esketamine versus an alfentanil adjunct to propofol sedation during endoscopic retrograde cholangiopancreatography: a randomised controlled multicentretrial[J]. Eur J Anaesthesiol, 2020, 37(5) : 394-401.
[11] 龙诗樱, 陈敏玲. 亚麻醉剂量氯胺酮-芬太尼辅助区域麻醉在小儿外科手术中的应用效果研究[J]. 当代医药论丛, 2022, 20(2) : 21-24.
[12] Hambrecht-Wiedbusch VS, Li D, Mashour GA.Paradoxical emergence: Administration of subanesthetic ketamine during isoflurane anesthesia induces burst suppression but accelerates recovery[J]. Anesthesiology, 2017, 126(3) : 482-494.
[13] 刘畑畑, 张芸芸, 张欣欣, 等. 亚麻醉剂量艾司氯胺酮对七氟醚麻醉脑电图特征的影响[J]. 国际麻醉学与复苏杂志, 2021, 42(10) : 1024-1028.
[14] 袁媛, 张杰, 岳红丽, 等. 无痛支气管镜检查麻醉方法的初步探讨[J]. 中华结核和呼吸杂志, 2019, 42(2) : 106-113.
[15] 贾涛, 滕金亮. 新型麻醉镇痛药: 艾司氯胺酮[J]. 中国临床药理学与治疗学, 2022, 27(07) : 834-840.
[16] Eberl S, Koers L, van Hooft JE, et al. Sedation with propofol during ERCP: is the combination with esketamine more effective and safer than with alfentanil? Study protocol for a randomized controlled trial[J]. Trials, 2017, 18(1) : 472.
[17] 龚晓毅, 翁立阳, 郭冬冬, 等. 小剂量艾司氯胺酮对无痛胃肠镜检查时丙泊酚联合瑞芬太尼在麻醉效果的影响[J]. 中国临床研究, 2022, 35(01) : 61-65.
[18] Tu W, Yuan H, Zhang S, et al.Influence of anesthetic induction of propofol combined with estamine on perioperative stress and inflammatory responsed and postoperative congnition of elderly surgical patients[J]. Am J Transl Res, 2021, 13(3) : 1701-1709.
[19] 王中玉, 李娟, 王安琪, 等. 亚麻醉剂量艾司氯胺酮对行膝关节置换术老年患者麻醉诱导期间血流动力学和应激反应的影响[J]. 中华实用诊断与治疗杂志, 2022, 36(1) : 88-92.
[20] Ebru TK, Resul K.Comparision of ketamine-propofol mixture (ketofol) and midazalam-meperridine in endoscopic retrograde cholangiopancretography (ERCP) for oldest old patients[J]. Ther Clin Risk Manag, 2019, 15: 755-763.
[21] Nakao S, Nagata A, Miyamoto E, et al.Inhibitory effect of propofol on ketamine-induced c-Fos expression in the rat posterior cingulate and retrosplenial cortices is mediated by GABAA receptor activation[J]. Acta Anaesthesiol Scand, 2003, 47(3) : 284-290.
[22] 钱夏丽, 夏凡, 沈晓凤, 等. 艾司氯胺酮复合丙泊酚在宫腔镜检查术中的应用[J]. 临床麻醉学杂志, 2021, 37(07) : 706-708.
[23] 康艺涵, 朱尤壮, 秦上媛, 等. 艾司氯胺酮的研究进展[J]. 中国医师进修杂志, 2021, 44(5) : 470-476.
[24] Trujilloo KA, Heller CY.Ketamine sensitization: Infulence of dose, environment, social isolation and treatment interval[J]. Behav Brain Res, 2020, 378: 112271.
基金
湖南省医学会医学科研基金（HNA202101013）
PDF(1902 KB)
