小剂量艾司氯胺酮弱阿片化麻醉在老年患者腰椎手术全身麻醉中的应用

Application of Low-dose Esketamine Weak Opioid Anesthesia in General Anesthesia for Lumbar Surgery in Elderly Patients

目的 评估小剂量艾司氯胺酮弱阿片化麻醉在老年腰椎手术患者中的临床麻醉效果。方法 选择2022年12月—2023年5月在安徽医科大学第三附属医院行全身麻醉下经椎间孔入路腰椎体融合手术的90例老年患者作为研究对象。按照随机数字表法分为E1组、E2组和C组各30例,剔除不符合病例,E1组、E2组各27例,C组29例。麻醉诱导时E1组、E2组均给予0.200 mg/kg艾司氯胺酮,术中维持时E1组、E2组分别给予0.250 mg/(kg·h)、0.125 mg/(kg·h)艾司氯胺酮持续泵注,C组麻醉诱导及维持均给予等量生理盐水。记录各组平均动脉压、心率、麻醉苏醒时间、围术期舒芬太尼药物用量、术后疼痛情况及不良反应发生情况。结果 E1组、E2组围术期舒芬太尼用量少于C组(P<0.05),术后30 min的疼痛评分低于C组(P<0.05),围术期低血压发生率及补救镇痛率低于C组(P<0.05)。E2组术后呼吸抑制发生率低于C组(P<0.05)。结论 在老年腰椎手术患者全身麻醉过程中应用小剂量艾司氯胺酮可以有效控制围术期疼痛,降低围术期阿片类药物消耗量,同时可维持老年患者的血流动力学稳定,降低术中低血压发生率,0.125 mg/(kg·h)的艾司氯胺酮有助于降低术后呼吸抑制发生率。

Objective To evaluate the clinical anesthetic effect of low-dose Esketamine weak opioid anesthesia in elderly patients undergoing lumbar spine surgery.Methods Ninety elderly patients who underwent lumbar body fusion via transforaminal approach under general anesthesia at the Third Affiliated Hospital of Anhui Medical University from December 2022 to May 2023 were selected as the study subjects.They were divided into the E1 group,E2 group and C group according to the random number table,each had 30 cases.Non-conforming cases were excluded,27 cases in the E1 group,27 cases in the E2 group and 29 cases in the C group.At the time of anesthesia induction,E1 and E2 groups were given 0.200 mg/kg Esketamine,during intraoperative maintenance,E1 and E2 groups were given 0.250 mg/(kg·h)and 0.125 mg/(kg·h)Esketamine by continuous pumping,respectively,and group C was given the same amount of saline for anesthesia induction and maintenance.Mean arterial pressure,heart rate,anesthesia recovery time,perioperative sufentanil dosage,postoperative pain and adverse reactions were recorded.Results In the E1 and E2 groups,the perioperative sufentanil dosage was less than that in the C group(P<0.05),the pain score at 30 min after surgery was lower than that in the C group(P<0.05),and the incidence of perioperative hypotension and rescue analgesia rate were lower than those in the C group(P<0.05).The incidence of postoperative respiratory depression in the E2 group was lower than that in the C group(P<0.05).Conclusion In the process of general anesthesia for lumbar spine surgery in elderly patients,the application of a small dose of Esketamine can effectively control perioperative pain,reduce perioperative opioid consumption,maintain hemodynamic stability in elderly patients,and reduce the incidence of hypotension during surgery,0.125 mg/(kg·h)of ketamine can help reduce the incidence of postoperative respiratory depression.