艾司氯胺酮联合右美托咪定在老年患者经皮椎体成形术中的应用

Effect of Esketamine Combined with Dexmedetomidine in Percutaneous Vertebroplasty in Elderly Patients

目的探讨艾司氯胺酮复合右美托咪定在老年患者经皮椎体成形术中的应用效果。方法选择骨质疏松性椎体压缩性骨折老年患者60例,随机分为D组(右美托咪定组,n=30)和KD组(艾司氯胺酮+右美托咪定组,n=30);协助患者俯卧位后,D组:给与右美托咪定负荷剂量1μg/kg,10 min内输注完毕,再给与右美托咪定0.4μg/(kg·h)持续泵注;KD组:给与右美托咪定负荷剂量1μg/kg,10 min内输注完毕,再给予艾司氯胺酮0.3 mg/kg及右美托咪定0.4μg/(kg·h)持续泵注;记录不同时间点的HR、MAP、SpO_(2)及Ramsay镇静评分,时间点包括T0(给予右美托咪定前)、T1(给予右美托咪定后10 min)、T2(给予右美托咪定后15 min)、T3(给予右美托咪定后30 min)及T4(给予右美托咪定后60 min);记录两组患者麻醉前及术后即刻VAS疼痛评分;观察两组患者的不良反应,包括恶心呕吐、呼吸抑制及苏醒期躁动精神症状等。结果与D组相比较,在T2时间点KD组患者的HR及MAP升高,差异具有统计学意(P<0.05);与D组相比较,在T2和T3时间点KD组患者的Ramsay镇静评分升高,差异具有统计学意义(P<0.05);KD组术后即刻VAS评分低于D组,差异具有统计学意义(P<0.05)。结论在经皮椎体成形术中老年患者采用艾司氯胺酮联合右美托咪定的麻醉,其镇痛、镇静效果明确,不良反应发生率低,是一种临床较合理的麻醉用药组合。

Objective To investigate the efficacy of esketamine combined with dexmedetomidine in percutaneous vertebroplasty in elderly patients.Methods 60 elderly patients with osteoporosis vertebral compression fracture were randomly divided into D group(dexmedetomidine group,n=30)and KD group(esketamine+dexmedetomidine group,n=30).After assisting the patients in prone position,for D group,the loading dose of dexmedetomidine was given 1μg/kg,the infusion was completed within 10 min,and then dexmedetomidine was given 0.4μg/(kg·h)continuous pumping,while for KD group,the loading dose of dexmedetomidine was given 1μg/kg,and the infusion was completed within 10min,followed by 0.3 mg/kg esticketamine and 0.4μg/(kg·h)dexmedetomidine continuous pumping;HR,MAP,SpO_(2) and Ramsay sedation scores at different time points were recorded,which included T0(before dexmedetomidine),T1(10 min after dexmedetomidine),T2(15 min after dexmedetomidine),T3(30 min after dexmedetomidine)and T4(60 min after dexmedetomidine);VAS pain scores before anesthesia and immediately after surgery were recorded.The adverse reactions of 2 groups were observed,including nausea and vomiting,respiratory depression and agitation during recovery.Results Compared with D group,the HR and MAP of KD group were higher at T2,and the difference was statistically significant(P<0.05);compared with D group,Ramsay sedation score at T2 and T3 in KD group was higher,and the difference was statistically significant(P<0.05);the postoperative VAS score of KD group was lower than that of D group,and the difference was statistically significant(P<0.05).Conclusion Esketamine combined with dexmedetomidine has clear analgesic and sedative effects and low incidence of adverse reactions in elderly patients undergoing percutaneous vertebroplasty.It is a reasonable combination of anesthetics in clinical practice.