艾司氯胺酮对心脏瓣膜置换术患者诱导期血流动力学及苏醒质量的影响
Effect of esketamine on hemodynamics during anesthesia induction and recovery quality of patients undergoing cardiac valve replacement
陈波 1熊兴龙 1蓝心 1邵仪 1陆俊 1唐光玲 1陈运滏 1史静1
作者信息
- 1. 贵州医科大学附属医院麻醉科,贵州贵阳 550004
- 折叠
摘要
目的 观察艾司氯胺酮对体外循环下心脏瓣膜置换术患者诱导期血流动力学及苏醒质量的影响.方法 择期行瓣膜置换术的116例患者随机均分为观察组和对照组,对照组采用0.05 mg/kg咪达唑仑、0.5 µg/kg舒芬太尼、0.6 mg/kg罗库溴铵以及0.3 mg/kg依托咪酯常规麻醉诱导,观察组在上述诱导方案实施前先静脉注射0.25 mg/kg艾司氯胺酮,诱导成功后行气管插管机械通气,两组患者采用相同方案行静吸复合麻醉维持;比较两组患者诱导期低血压的发生率,观察麻醉诱导前(T0)、给药后1 min(T1)、插管后即刻(T2)及插管后5 min(T3)时间点的心率、血压等变化情况及苏醒质量.结果 观察组诱导期低血压的发生率低于对照组(P＜0.05),观察组T1时点的平均动脉压(MAP)变化幅度、诱导期△MAP低于对照组(P＜0.05);两组心脏瓣膜疾病手术患者心率、恶心呕吐、苏醒期躁动及拔管时间比较,差异无统计意义(P＞0.05);观察组手术患者重症监护室(ICU)停留时间较对照组缩短(P＜0.05).结论 艾司氯胺酮能降低体外循环心脏瓣膜置换术患者诱导期低血压的发生率,维持诱导期的血流动力学相对稳定,但不影响患者的拔管时间和苏醒期并发症.
Abstract
Objective To observe the effects of esketamine on the hemodynamics during the induction period and recovery quality of patients undergoing cardiac valve replacement with cardiopulmonary bypass(CPB).Methods A total of 116 patients undergoing cardiac valve replacement were randomly divided into observation and control groups.Control group was given with 0.05 mg/kg midazolam,0.5 μg/kg sufentanil,0.6 mg/kg rocuronium bromide,and 0.3 mg/kg etomidate for routine induction of anesthesia.Observation group was given with intravenous injection of 0.25 mg/kg esketamine before the implementation of the above induction protocol.After successful induction,tracheal intubation was performed for mechanical ventilation.Both groups were maintained by static inhalation compound anesthesia with the same protocol.The incidences of hypotension during induction were compared between two groups of patients.The changes in heart rate,blood pressure and recovery quality were observed at time points before anesthesia induction(T0),1 minute after administration(T1),immediately after intubation(T2),and 5 minutes after intubation(T3).Results The incidence of hypotension during the induction period was significantly lower in observation group than that in control group(P＜0.05).Change amplitude of mean arterial pressure(MAP)at T1 and△MAP during the induction period were significantly lower in observation group than those in control group(P＜0.05).There were no significant differences in heart rate,nausea and vomiting,agitation during the awakening period and extubation time between two groups(P＞0.05).The length of intensive care unit(ICU)stay was significantly shorter in observation group than that in control group(P＜0.05).Conclusion Esketamine can reduce the incidence of hypotension during the induction period in patients undergoing cardiac valve replacement with CPB and maintain relatively stable hemodynamics during the induction period,without affecting the patient's extubation time and complications during the recovery period.
关键词
艾司氯胺酮/体外循环/心脏瓣膜置换术/血流动力学/麻醉诱导Key words
esketamine/cardiopulmonary bypass/cardiac valve replacement/hemodynamics/anesthesia induction引用本文复制引用
出版年
2024
NETL
NSTL
万方数据