首页|右美托咪定联合艾司氯胺酮麻醉在冠心病非心脏手术中效果研究

右美托咪定联合艾司氯胺酮麻醉在冠心病非心脏手术中效果研究

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目的:分析右美托咪定联合艾司氯胺酮麻醉对冠心病非心脏手术效果及对患者血流动力学、应激反应与术后并发症的影响.方法:选取2021年10月至2022年11月在我院拟行腔镜下腹部手术治疗的106例冠心病患者为研究对象,将其随机分为对照组和观察组,各53例,均行常规手术治疗.对照组麻醉药物选用右美托咪定,观察组选用右美托咪定联合艾司氯胺酮麻醉,对比2组患者手术指标、术后并发症与不同时点呼吸频率(RR)、心率(HR)、舒张压(DBP)、收缩压(SBP)、疼痛视觉模拟评分(VAS)、Ramsay镇静评分、超氧化物歧化酶(SOD)、丙二醛(MDA)、皮质醇(Cor)、血糖(GLU)水平.结果:2组患者的手术时间差异无统计学意义(P>0.05),但观察组术后舒芬太尼用量低于对照组、有效按压次数高于对照组(P<0.05).术后12 h,2组VAS评分、Ramsay镇静评分比较差异均无统计学意义(P>0.05),术后4、8 h观察组VAS评分、Ramsay镇静评分均优于对照组(P<0.05).2组患者术后4 h的MDA、GLU、Cor水平均升高,SOD水平均降低(P<0.05),且术后4 h观察组SOD水平高于对照组,MDA、GLU、Cor水平均低于对照组(P<0.05).麻醉前,2组血流动力学指标差异均无统计学意义(P>0.05);与麻醉前相比,2组术毕、术后24 h的HR、SBP、DBP、RR均存在改变(P<0.05),但观察组术毕、术后24 h的HR、SBP、DBP、RR均优于对照组(P<0.05).观察组的术后并发症发生率低于对照组(P<0.05).结论:右美托咪定联合艾司氯胺酮能够有效稳定患者的血流动力学,降低患者术后应激反应,并减少术后并发症的发生.
Effect of dexmedetomidine combined with esketamine anesthesia in non-cardiac surgery for coronary artery disease
Objective:To analyze the effect of dexmedetomidine combined with esketamine anesthesia on non-cardiac surgery for coronary heart disease and the effect on hemodynamics,stress response and postoperative complications of patients.Method:A total of 106 patients with coronary heart disease who were going to undergo laparoscopic abdominal surgery from Oct 2021 to Nov 2022 in our hospital were selected and randomly divided into the control group and the observation group,with 53 cases in each group.All patients underwent conventional surgical treatment.The control group was given dexmedetomidine anesthesia,while the observation group was given dexmedetomidine combined with esketamine anesthesia.The surgical indicators,incidence of postoperative complications,diastolic blood pressure(DBP),systolic blood pressure(SBP),pain visual analog scale(VAS),Ramsay sedation score,and the levels of oxide dismutase(SOD),malondialdehyde(MDA),cortisol(Cor)and blood glucose(GLU)were compared between the two groups.Results:There was no statistically significant difference in the operation time between the two groups(P>0.05),but the postoperative sufentanil dosage of the observation group was lower than that of the control group,and the number of effective compressions was higher than that of the control group(P<0.05).At 12 h postoperatively,there was no significant difference between the VAS score and Ramsay sedation score of the two groups(P>0.05),and the VAS score and Ramsay sedation score in the observation group were better than those in the control group at 4 h and 8 h postoperatively(P<0.05).The levels of MDA,GLU and Cor in both groups increased and the level of SOD decreased at 4 h postoperatively(P<0.05),and the level of SOD in the observation group was higher than that of the control group,and the levels of MDA,GLU and Cor were lower than those of the control group(P<0.05).Before anesthesia,there was no statisti-cally significant difference in hemodynamic indexes between the two groups(P>0.05).Compared with before anesthesia,there were changes in HR,SBP,DBP,and RR of the two groups at the end of the operation and 24 h after the operation(P<0.05),and the HR,SBP,DBP,and RR of the observation group were better than those of the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).Conclusion:Dexmedetomidine combined with esketamine anesthesia can effectively stabilize the hemodynamics of patients,reduce postoperative stress response,and reduce postoperative complications.

dexmedetomidineesketaminecoronary heart diseasehemodynamicsstress responsecomplications

汪东升、张从利、张阳、庄芹、李晓红

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蚌埠医学院第一附属医院麻醉科,安徽 蚌埠 233000

右美托咪定 艾司氯胺酮 冠心病 血流动力学 应激反应 并发症

2024

沈阳医学院学报
沈阳医学院

沈阳医学院学报

影响因子:0.591
ISSN:1008-2344
年,卷(期):2024.26(3)