全身麻醉下行腰椎融合术患者应用小剂量艾司氯胺酮的效果

Efficacy of low-dose esketamine in patients undergoing lumbar fusion under general anesthesia

目的观察全身麻醉(全麻)下行腰椎融合术患者应用小剂量艾司氯胺酮的效果。方法择期行腰椎融合术患者60例随机分为两组,每组30例。两组均采用静脉-吸入复合全麻。A组麻醉诱导时静脉注射艾司氯胺酮0.2mg/kg,继以2μg·kg^(-1)·min^(-1)静脉泵注至术毕;C组仅给予等量生理盐水作为对照。比较两组围手术期MAP和HR变化,检测麻醉诱导前和拔管后5min时的血清IL-6和皮质醇(Cor)水平,评估VAS疼痛评分。记录围手术期相关指标和术后不良反应发生情况。结果与C组比较,A组插管前MAP和HR升高,拔管后即刻MAP和HR降低(P<0.05)。拔管后5min,A组血清IL-6和Cor水平以及咳嗽状态下VAS疼痛评分均低于C组(P<0.05或P<0.01)。与C组比较,A组围手术期舒芬太尼和丙泊酚消耗量以及术后补救镇痛患者比例降低,但术后升压药物使用患者比例和头晕头痛发生率升高(P<0.05或P<0.01)。结论应用小剂量艾司氯胺酮有利于维持全麻腰椎融合术患者循环稳定,减轻应激反应和术后疼痛,但需警惕静脉泵注艾司氯胺酮可能发生的心血管及神经系统不良事件。

Objective To observe the efficacy of low-dose esketamine in the patients undergoing lumbar fusion under general anesthesia.Methods Sixty patients undergoing lumbar fusion under combined venous-inhalation general anesthesia were randomly divided into two groups with 30cases each.During anesthesia induction,esketamine 0.2 mg/kg was injected intravenously,which was followed by 2μg·kg^(-1)·min^(-1) intravenously pumping until the end of the operation in group A,while equal amount of normal saline instead of esketamine was given in group C as the control.The changes of MAP and HR were compared between the two groups.Serum levels of IL-6and cortisol(Cor)were detected and VAS pain scores were evaluated before anesthesia induction and at 5minutes after extubation.The relevant perioperative indicators and the occurrence of postoperative adverse reactions were recorded.Results Compared with group C,MAP and HR before intubation were increased,which immediately after extubation were decreased in group A(P<0.05).Serum levels of IL-6and Cor and VAS pain score during coughing at 5minutes after extubation were lower in group A than those in group C(P<0.05or P<0.01).Compared with group C,perioperative sufentanil and propofol consumptions and proportion of remedial analgesia were lower,while proportion of using drugs raising blood pressure and incidence of dizziness and headache after operation were higher in group A(P<0.05or P<0.01).Conclusion The application of small-dose esketamine is beneficial to maintain circulatory stability in the patients undergoing lumbar fusion under general anesthesia,which has the advantages of reducing stress response and postoperative pain,but we should be alert to the possible cardiovascular and neurological adverse events associated with intravenous pumping of esketamine.