艾司氯胺酮预处理在臂丛神经阻滞老年手术患者的应用

Application of esketamine pretreatment in elderly surgical patients under brachial plexus block

目的观察艾司氯胺酮预处理在臂丛神经阻滞老年手术患者的应用效果。方法在罗哌卡因臂丛麻醉下行上肢手术老年患者60例随机分为K组和C组,每组30例。K组手术切皮前10 min缓慢静脉注射艾司氯胺酮0.5 mg/kg。记录麻醉前(T0)、臂丛阻滞完毕后15 min(T1)和30 min(T2)及术毕(T3)的SpO2、MAP和HR,并同时检测血清皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)及血糖(BG)。记录术后不良反应发生情况。结果C组T1~T3时的MAP、HR、NE、E、Cor和BG水平均高于T0(P<0.05),且高于K组(P<0.05)。K组术后需要追加镇痛药的比例小于C组(P<0.05)。术后两组患者均未出现明显不良反应。结论艾司氯胺酮预处理能减少臂丛神经阻滞下上肢手术老年患者的应激反应。

Objective To observe the efficacy of esketamine pretreatment in elderly surgical patients under brachial plexus block.Methods Sixty elderly patients undergoing upper limb surgery under brachial plexus block with 0.33%ropivacaine were assigned into two groups of K and C with 30 cases each.Esketamine 0.5 mg/kg was infused in 10 minutes before skin incision in group K.At the time points of before anesthesia(T0),15 min(T1)and 30 min after brachial plexus block(T2)and at the end of operation(T3),SpO2,MAP and HR were recorded and serum cortisol(Cor),epinephrine(E),norepinephrine(NE)and blood glucose(BG)were detected at the same times.The postoperative adverse responses were observed as well.Results MAP,HR,NE,E,Cor and BG at T1 to T3 in group C were higher than those at T0(P<0.05),which were higher than those in group K(P<0.05).The percentage of the patients using supplemental analgesics postoperatively was higher in group C than that in group K(P<0.05).There were no obvious adverse responses in the two groups.ConclusionEsclamine pretreatment can reduce stress response in elderly patients undergoing upper limb surgery under brachial plexus block.