小剂量艾司氯胺酮联合右美托咪定在老年患者椎体成形术麻醉中的应用

doi:10.16352/j.issn.1001-6325.2022.06.020

基础医学与临床 ›› 2022, Vol. 42 ›› Issue (6): 950-954.doi: 10.16352/j.issn.1001-6325.2022.06.020

小剂量艾司氯胺酮联合右美托咪定在老年患者椎体成形术麻醉中的应用

任海强^1#, 李雷^1#, 杨旺燕¹, 杜鹃¹, 姜丹丹¹, 闫莉², 傅润乔^1*

1.清华大学附属垂杨柳医院麻醉科, 北京 100022;
2.中国医学科学院基础医学研究所北京协和医学院基础学院病理生理学系, 北京 100005

收稿日期:2022-02-22 修回日期:2022-04-25 出版日期:2022-06-05 发布日期:2022-06-02
通讯作者: * runqiao63@163.com
作者简介:^#对本文有同等贡献
基金资助:
国家自然科学基金(81470540)

Application of low-dose esketamine combined with dexmedetomidine in anesthesia for elderly patients with percutaneous vertebroplasty

REN Hai-qiang^1#, LI Lei^1#, YANG Wang-yan¹, DU Juan¹, JIANG Dan-dan¹, YAN Li², FU Run-qiao^1*

1. Department of Anesthesiology, Chuiyangliu Hospital Affiliated to Tsinghua University, Beijing 100022;
2. Department of Pathophysiology, Institute of Basic Medical Sciences CAMS, School of Basic Medicine PUMC, Beijing 100005, China

Received:2022-02-22 Revised:2022-04-25 Online:2022-06-05 Published:2022-06-02
Contact: * runqiao63@163.com

摘要/Abstract

摘要： 目的探讨艾司氯胺酮联合右美托咪定用于老年患者行椎体成形术(PVP)中的静脉镇痛、镇静麻醉效果。方法选择2021年3月至11月行椎体成形术的72例、年龄70~90岁老年患者,按照随机数字表法将其分为对照组(SF-DEX, n=36)和实验组(EK-DEX, n=36), 实施安定镇痛麻醉。所有患者静脉泵注右美托咪定0.5 μg/kg(10 min)。俯卧位后,SF-DEX组静注舒芬太尼5 μg(1 μg/mL),然后持续输注右美托咪定0.5 μg/(kg·h)维持至手术结束前5 min;EK-DEX组静注负荷量艾司氯胺酮0.1 mg/kg(1 mg/mL),然后持续泵注0.1 mg/(kg·h)至手术结束前5 min。分别记录在给药前(T1)、手术开始(T2)、灌注骨水泥(T3)、术毕(T4)4个时点的循环指标(SAP、DAP、MAP、HR)、呼吸指标(SpO₂)、BIS变化、疼痛程度(VAS评分)、镇静状态(Ramsay评分)及血压波动幅度、是否心律失常、 SpO₂下降幅度等情况。结果 SF-DEX组在T3较T1时SAP、MAP 明显降低(P＜0.05);T2、T3时Ransay评分均升高(P＜0.05);EK-DEX组在T2、T3时 VAS评分明显低于SF-DEX组(P＜0.05);EK-DEX组在T3时 Ransay评分明显高于SF-DEX组(P＜0.05)。两组术后未见低血压、心率减慢、氧饱和度降低等不良反应及并发症。结论应用小剂量艾司氯胺酮联合小剂量右美托咪定能够在老年甚至高龄患者椎体成形术(PVP)围术期产生良好镇静镇痛效果,无明显并发症,是一种安全可行的方法。

关键词: 艾司氯胺酮, 镇痛, 镇静, 老年, 椎体成形术

Abstract: Objective To investigate the effects of low-esmketamine combined with dexmedetomidine on intra-venous analgesia, sedation in elderly patients undergoing percutaneous vertebroplasty (PVP). Methods A total of seventy-two elderly patients aged 70-90 years old who underwent PVP in Beijing Chuiyangliu hospital between March to November 2021 were enrolled in this study. Patients were assigned randomly by a random number table method into controll group (SF-DEX, n=36) and test group (ES-DEX, n=36) for the seddative analgesia anesthesia. All patients were accepted a 0.5 μg/kg dexmedetomidine by pump into venous within 10 min, the other 5 μg sufentanil was gived venously and then 0.5 μg/(kg·h) dexmedetomidine by pump in SF-DEX. 0.1 mg/kg esketamine was gived venously and then 0.1 mg/(kg·h) by pump in EK-DEX. The changes of circulatory indexes systolis arterial pressure(SAP),diastolis arterial pressure(DAP),mean arterial pressure(MAP),heart rate(HR), saturated oxygen (SpO₂), BIS indexes, pain intensity (VAS), Ramsay score for sedation level, blood pressure variation, arrhythmia and decrease range of SpO₂, were measured respectively at four time points before administration (T1), at time of operation start (T2), filling bone cement (T3), at the end of operation (T4) between two groups. Results SAP,MAP was significantly lower at T3 than that at T1 (P＜0.05) in SF-DEX; the Ramsay score was increased at T2 and T3 (P＜0.05).The VAS score in EK-DEX group was significantly lower than that in SF-DEX group at T2 and T3 (P＜0.05); the Ramsay score in EK-DEX group was significantly increased than that in SF-DEX group at T3 (P＜0.05). The incidences and hemodynamic adverse effects such as hypotension, bradycardia and desaturation, were not significantly different between the groups. Conclusions Low-dose esketamine combined with low-dose dexmedetomidine for anesthesia produces satisfactory analgesic and sedation effect in elderly patients with PVP without obvious complications. It is a safe and feasible method.

Key words: esmketamine, analgesia, sedation, elderly patients, percutaneous vertebroplasty

中图分类号:

R614

任海强, 李雷, 杨旺燕, 杜鹃, 姜丹丹, 闫莉, 傅润乔. 小剂量艾司氯胺酮联合右美托咪定在老年患者椎体成形术麻醉中的应用[J]. 基础医学与临床, 2022, 42(6): 950-954.

REN Hai-qiang, LI Lei, YANG Wang-yan, DU Juan, JIANG Dan-dan, YAN Li, FU Run-qiao. Application of low-dose esketamine combined with dexmedetomidine in anesthesia for elderly patients with percutaneous vertebroplasty[J]. Basic & Clinical Medicine, 2022, 42(6): 950-954.

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小剂量艾司氯胺酮联合右美托咪定在老年患者椎体成形术麻醉中的应用

Application of low-dose esketamine combined with dexmedetomidine in anesthesia for elderly patients with percutaneous vertebroplasty

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