摘要
目的:探讨研究心脏瓣膜手术中依托咪酯联合氯胺酮麻醉的应用及对患者RAP、PTRI、SVRI的影响。方法:选取2019年6月-2020年2月本院收治的78例心脏瓣膜手术患者,根据术中持续麻醉不同药物分成研究组和对照组,每组39例。两组均使用同样的方法进行麻醉诱导,对照组应用右美托咪定,研究组应用依托咪酯联合氯胺酮。比较两组麻醉前(T_(0))、麻醉诱导后(T_(1))、气管插管后(T_(2))、切皮后(T_(3))、劈胸骨时(T_(4))、吊心包(T_(5))及CPB前(T_(6))的相关血流动力学指标[心率(HR)、平均动脉压(MAP)、肺循环阻力指数(PTRI)、右房压(RAP)、体循环阻力指数(SVRI)],比较两组手术中使用血管活性药物的用量及术前和术后1、3、7 d的MMSE评分。结果:T_(0)、T_(1)时,两组HR、MAP、PTRI、RAP及SVRI比较,差异均无统计学意义(P>0.05)。T_(1)时,且两组HR、MAP、PTRI、RAP及SVRI与T_(0)时比较,差异均无统计学意义(P>0.05)。T_(2)~T_(6)时,两组HR、MAP、PTRI、RAP及SVRI比较,差异均有统计学意义(P<0.05);且研究组HR、MAP、PTRI、RAP及SVRI与T_(0)、T_(1)时比较,差异均无统计学意义(P>0.05)。研究组多巴胺和去氧肾上腺素用量均低于对照组,差异均有统计学意义(P<0.05)。术前,两组MMSE评分比较,差异无统计学意义(P>0.05);术后1、3、7 d,研究组MMSE评分均高于对照组,差异均有统计学意义(P<0.05)。结论:给予心脏瓣膜手术患者在手术过程中联合使用依托咪酯及氯胺酮进行维持麻醉,可有效降低患者在手术过程中的血流动力学波动,维持各项指标稳定;同时还可以提高术后患者的MMSE评分,降低患者发生认知障碍的风险。
Objective:To investigate the application of Etomidate combined with Ketamine anesthesia in cardiac valve surgery and its influence on RAP,PTRI and SVRI.Method:A total of 78 patients with cardiac valve surgery in our hospital from June 2019 to February 2020 were selected,and they were divided into study group and control group according to the different drugs of continuous anesthesia during surgery.The two groups were given the same anesthesia induction method,the control group was given Dexmedetomidine,and the study group was given Etomidate combined with Ketamine.The related hemodynamic indicators[heart rate (HR),mean arterial pressure (MAP),pulmonary circulatory vascular resistance index (PTRI),right atrial pressure (RAP),systemic vascular resistance index (SVRI)]before anesthesia (T_(0)),after induction of anesthesia (T1),after tracheal intubation (T_(2)),after skin incision (T_(3)),sternum split (T_(4)),pericardium (T_(5)) and before CPB (T_(6)) were compared between two groups,the dosage of vasoactive drugs used in the surgery and the MMSE scores before and 1,3,and 7 d after surgery were compared between two groups.Result:At T_(0) and T1,there were no significant differences in HR,MAP,PTRI,RAP and SVRI between the two groups (P>0.05).At T1,and there were no significant differences in HR,MAP,PTRI,RAP and SVRI of two groups compared with those at T_(0) (P>0.05).At T_(2)~ T_(6),there were significant differences in HR,MAP,PTRI,RAP and SVRI between two groups (P<0.05);there were no significant differences in HR,MAP,PTRI,RAP and SVRI of study group compared with those at T_(0) and T1 (P>0.05).The dosages of Dopamine and Phenylephrine of the study group were lower than those of the control group,and the differences were statistically significant (P<0.05).Before surgery,there was no significant difference in MMSE scores between two groups (P>0.05);1,3,and 7 d after surgery,the MMSE scores of the study group were higher than those of the control group,and the differences were statistically significant (P<0.05).Conclusion:The combination of Etomidate and Ketamine for maintenance anesthesia in patients undergoing cardiac valve surgery can effectively reduce the hemodynamic fluctuation during the surgery and maintain the stability of various indicators;at the same time,it can also improve the MMSE score of postoperative patients,and reduce the risk of cognitive impairment in patients.
作者
杨小强
刘成森
张小亮
韦华
YANG Xiaoqiang;LIU Chengsen;ZHANG Xiaoliang;WEI Hua(The People’s Hospital of Gaozhou,Gaozhou 525200,China)
出处
《中国医学创新》
CAS
2021年第22期90-94,共5页
Medical Innovation of China
