摘要
目的观察亚麻醉剂量盐酸艾司氯胺酮在髋关节置换术中的麻醉诱导和维持以及术后镇痛的临床应用,为其临床使用提供理论依据。方法选择2020年12月-2021年7月沈阳市第五人民医院拟行髋关节置换的患者60例,按照随机数字表法分为2组,观察组即盐酸艾司氯胺酮组和对照组即舒芬太尼组,每组患者30例。观察组麻醉诱导采用舒芬太尼0.2μg/kg+盐酸艾司氯胺酮0.3 mg/kg,麻醉维持采用舒芬太尼+盐酸艾司氯胺酮+七氟醚,术后镇痛配方:舒芬太尼100μg+盐酸艾司氯胺酮100 mg+托烷司琼5 mg,加生理盐水至总量100 ml;对照组麻醉诱导采用单纯的舒芬太尼0.5μg/kg,麻醉维持采用舒芬太尼+七氟醚,术后镇痛配方:舒芬太尼200μg+托烷司琼5 mg,加生理盐水至总量100 ml。记录患者入室后10 min及插管即时、手术切皮时、拔管即时和拔管5 min后的平均动脉压和心率,同时观察患者术后0.5 h、2 h、6 h、12 h、24 h和48 h的VAS评分和Ramsay评分及相应时间点的恶心、呕吐、皮肤瘙痒、呼吸抑制、精神症状等不良反应和医生、患者满意度。结果观察组的插管即时、手术切皮时和拔管即时的平均动脉压变化量和心率的变化量显著低于对照组,两组比较差异具有统计学意义(P<0.05);术后0.5 h、术后2 h观察组的VAS评分显著低于对照组、Ramsay评分显著高于对照组,两组比较差异具有统计学意义(P<0.05);两组的恶心、呕吐、皮肤瘙痒和呼吸抑制等不良反应发生率观察组显著低于对照组,两组比较差异具有统计学意义(P<0.05);患者、医生满意度观察组显著高于对照组,两组比较差异具有统计学意义(P<0.05)。结论亚麻醉剂量盐酸艾司氯胺酮用于髋关节置换术的患者麻醉诱导和维持血流动力学更加稳定,联合舒芬太尼用于术后镇痛效果更好,医生和患者的满意度更高,而且不良反应更少。
Objective To investigate the clinical application of subanesthetic dose of esketamine in induction and maintenance of anesthesia and postoperative analgesia in hip replacement,and to provide a theoretical basis for its clinical application.Methods Sixty patients scheduled for hip replacement in Shenyang Fifth People′s Hospital from December 2020 to July 2021 were selected and divided into two groups according to the random number table method.The observation group was esketamine group(group ES)and the control group was sufentanil group(group SF),with 30 patients in each group.Sufentanil 0.2μg/kg+esketamine hydrochloride 0.3 mg/kg was used for anesthesia induction in group ES.Sufentanil+esketamine hydrochloride+sevoflurane was used for anesthesia maintenance.The postoperative analgesic formula was as follows:sufentanil 100μg+esketamine 100 mg+tropisetron 5 mg,and normal saline was added to the total amount of 100 ml.In group SF,0.5μg/kg sufentanil was used for anesthesia induction,and sufentanil+sevoflurane was used for anesthesia maintenance.The postoperative analgesic formula was 200μg sufentanil+5 mg tropisetron,and normal saline was added to the total amount of 100 ml.Mean arterial pressure(MAP)and heart rate(HR)were recorded at 10 minutes after admission.MAP and HR were recorded at intubation,skin incision,extubation and 5 minutes after extubation.At the same time,the VAS score and Ramsay score at 0.5 h,2 h,6 h,12 h,24 h and 48 h after operation,as well as the adverse reactions such as nausea,vomiting,skin itching,respiratory depression and mental symptoms at the corresponding time points and the satisfaction of doctors and patients were observed.Results The changes of mean arterial pressure and heart rate in ES group were significantly lower than those in SF group at the time of intubation,skin incision and extubation(P<0.05).VAS scores at 0.5 h and 2 h after operation in ES group were significantly lower than those in SF group,while Ramsay scores were significantly higher than those in SF group,with statistically significant differences(P<0.05).The incidence of adverse reactions such as nausea,vomiting,pruritus and respiratory depression in ES group was significantly lower than that in SF group,and the difference was statistically significant(P<0.05).The satisfaction of patients and doctors in ES group was significantly higher than that in SF group(P<0.05).Conclusion The anesthesia induction and hemodynamic maintenance for patients with hip replacement by subanesthetic dose of esketamine hydrochloride is stable.The analgesic effect of combining sufentanil for postoperative analgesia is better.The satisfaction degree of doctors and patients is higher,and the adverse reactions are fewer.
作者
周萍
朱玉梅
张维清
郝建礼
ZHOU Ping;ZHU Yu-mei;ZHANG Wei-qing;HAO Jian-li(Department of Anesthesiology,Shenyang Fifth People′s Hospital,Shenyang 110023,China;Department of Anesthesiology,Cancer Hospital of China Medical University Liaoning Cancer Hospital,Shenyang 110042,China)
出处
《实用药物与临床》
CAS
2022年第2期159-163,共5页
Practical Pharmacy and Clinical Remedies
关键词
艾司氯胺酮
髋关节置换术
全身麻醉
术后镇痛
Esketamine
Hip replacement
General anesthesia
Postoperative analgesia
