艾司氯胺酮在临床麻醉中应用进展

Advances in the application of esketamine in clinical anesthesia

艾司氯胺酮作为外消旋氯胺酮的对映体,因其较少的副作用而在临床上倍受关注。相较于外消旋氯胺酮,艾司氯胺酮具有更强的受体亲和力、更快的起效速度、更高的清除率和更可控的效果。近年来,艾司氯胺逐渐成为多模式镇痛的重要组成部分,并在临床麻醉中得到推广。文章综述了艾司氯胺酮的药理特性、临床麻醉中的应用和副作用,重点关注了其在围手术期急性和慢性疼痛、血流动力学、术后认知功能、术后恢复质量、产后抑郁、儿科麻醉、急性颅脑损伤、无痛诊疗和无阿片麻醉等方面的研究进展和趋势,旨在为艾司氯胺酮的临床应用和未来研究提供参考。

Esketamine,as the enantiomer of racemic ketamine,has garnered considerable attention in clinical practice due to its fewer side effects.In comparison with racemic ketamine,esketamine exhibits strong receptor affinity,fast onset of action,high clearance rate,and easy control effects.In recent years,it has gradually become an integral component of multimodal analgesia and has been promoted in clinical anesthesia.This review provides a comprehensive summary of the pharmacological properties,clinical applications,and side effects of esketamine,with a particular focus on its research advances and trends in various aspects including perioperative acute and chronic pain,hemodynamics,postoperative cognitive function,postoperative recovery quality,postpartum depression,pediatric anesthesia,acute brain injury,painless diagnosis and treatment,and opioid-free anesthesia,aiming to provide a reference for the clinical application and future research of esketamine.