摘要
目的观察低剂量艾司氯胺酮用于老年患者全麻诱导对血流动力学和术后谵妄(POD)的影响。方法选取2023年9月至2024年1月蚌埠市第二人民医院60例全麻气管插管状态下择期行关节置换术的老年患者作为研究对象。采用随机数字表法分为艾司氯胺酮组(S组)和对照组(C组),每组30例,S组诱导过程中给予艾司氯胺酮0.3 mg/kg,C组给予等容量的生理盐水。记录患者入室(T_(0))、气管插管前(T_(1))、气管插管后1 min(T_(2))、插管后3 min(T_(3))和插管后5 min(T_(4))的动脉血压(ABP)、心率(HR),3 d内的POD和不良反应发生率以及48 h内补救镇痛情况。结果整体分析结果显示,两组患者的SBP、DBP、MAP和HR不同时点比较,差异有统计学意义(P<0.05);SBP、DBP及MAP组间及交互作用比较,差异无统计学意义(P>0.05);HR组间比较,差异无统计学意义(P>0.05),交互作用比较,差异有统计学意义(P>0.05)。两组SDP、DBP、MAP各时点、POD和不良反应发生率以及48 h内补救镇痛率比较,差异无统计学意义(P>0.05)。C组T_(1)和T_(4)时HR低于S组,差异有统计学意义(P<0.05);两组患者T_(1)、T_(3)和T_(4)时的SBP、DBP及MAP低于本组T_(0)时,差异有统计学意义(P<0.05);C组患者T_(1)、T_(3)和T_(4)时HR低于本组T_(0)时,差异有统计学意义(P<0.05);S组T_(1)时HR低于本组T_(0)时,差异有统计学意义(P<0.05)。结论低剂量艾司氯胺酮可以稳定老年患者全麻诱导过程中的血流动力学,而对POD发生率的影响不明显。
Objective To observe the effect of low dose Esketamine on hemodynamics and postoperative delirium(POD)in elderly patients induced by general anesthesia.Methods A total of 60 elderly patients undergoing joint replacement under general anesthesia under tracheal intubation in Bengbu Second People's Hospital from September 2023 to January 2024 were selected as the study objects.They were divided into Esketamine group(group S)and control group(group C)by random number table method,with 30 cases in each group.In group S,Esketamine 0.3 mg/kg was given during induction.Group C was given equal volume of normal saline.Arterial blood pressure(ABP),heart rate(HR),POD and incidence of adverse reactions within 3 days,and relief analgesia within 48 h were recorded at home(T_(0)),before endotracheal intubation(T_(1)),1 min after endotracheal intubation(T_(2)),3 min after endotracheal intubation(T_(3)),and 5 min after endotracheal intubation(T_(4)).Results The overall analysis results showed that there were significant differences in SBP,DBP,MAP and HR between two groups at different time points(P<0.05).There were no significant differences in SBP,DBP and MAP between groups and their interaction(P>0.05).There was no significant difference between the HR groups(P>0.05),and there was significant difference between the interaction groups(P>0.05).There were no significant differences in the incidence of SDP,DBP,MAP at each time point,POD and adverse reactions and the rate of relief analgesia within 48 h between the two groups(P>0.05).HR in group C was lower than that in group S at T_(1) and T_(4),and the differences were statistically significant(P<0.05).The SBP,DBP and MAP of the two groups at T_(1),T_(3) and T_(4) were lower than that at T_(0),and the differences were statistically significant(P<0.05).HR in group C at T_(1),T_(3) and T_(4) was lower than T_(0) in group C,and the differences were statistically significant(P<0.05).HR of T_(1) in group S was lower than that of T_(0),and the difference was statistically significant(P<0.05).Conclusion Low dose Esketamine can stabilize hemodynamics during induction of general anesthesia in elderly patients,but has no significant effect on POD incidence.
作者
邓书
徐康
梅俊峰
王超
马沙沙
胡宪文
DENG Shu;XU Kang;MEI Junfeng;WANG Chao;MA Shasha;HU Xianwen(Department of Anesthesiology,Bengbu Second People's Hospital,Anhui Province,Bengbu233000,China;Department of Anesthesiology,the Second Affiliated Hospital of Anhui Medical University,Anhui Province,Hefei230071,China)
出处
《中国当代医药》
2025年第6期106-109,114,共5页
China Modern Medicine
基金
安徽省重点开发与研究项目(2022e07020045)。
关键词
艾司氯胺酮
老年人
术后谵妄
麻醉诱导
Esketamine
Elderly
Postoperative delirium
Anesthesia induction
