摘要
目的探讨缺血性脑卒中患者进行结直肠癌手术时,艾司氯胺酮对于全麻诱导后低血压的预防效果及其安全性。方法2023年7月至2023年12月在天津市人民医院选择140例患有缺血性脑卒中并接受腹腔镜结直肠癌根治术的患者。按照随机数字表法分为两组:对照组(n=70),给予常规麻醉,观察组(n=70),在常规麻醉基础上加用艾司氯胺酮。记录麻醉诱导后低血压(PIH)发生率、记录麻醉诱导前(T0)、诱导后气管插管前(T1)、气管插管后1 min(T2)、诱导后15 min(T3)、诱导后20 min(T4)时平均动脉压(MAP)和心率(HR)的变化,对比两组的不良反应情况。结果诱导后插管前(T1)和插管后(T2、T3、T4),观察组PIH均低于对照组(χ^(2)=4.766,3.897,3.962,4.743,均P<0.05)。组内比较,观察组诱导后气管插管前(T1)PIH的发生率最高,诱导后20 min(T4)发生率最低,而对照组气管插管后PIH发生率较气管插管前降低,差异有统计学意义(均P<0.05)。与T0基线水平相比,两组患者的MAP和HR在T1、T2、T3、T4各时间点均降低(均P<0.05),且在T1、T2、T3、T4各时间点,观察组的MAP[(84.1±12.0)mm Hg,(84.8±11.2)mm Hg,(85.0±11.8)mm Hg,(87.8±11.9)mm Hg]均高于对照组[(78.4±13.1)mm Hg,(80.8±12.8)mm Hg,(81.8±13.3)mm Hg,(83.0±14.5)mm Hg](均P<0.05)。观察组HR在T1低于对照组[(64.8±10.6)次·min^(-1),(65.6±12.6)次·min^(-1)],差异有统计学意义(P<0.05),在T0、T2、T3、T4均差异无统计学意义(均P>0.05)。观察组严重心动过缓发生率为[4.3%(3/70)]低于对照组[14.3%(10/70)],差异有统计学意义(χ^(2)=20.660,P<0.05)。结论在缺血性脑卒中患者的全麻诱导中使用艾司氯胺酮有助于降低诱导后低血压的风险。
Objective To investigate the preventive effect of esketamine on hypotension in colorectal cancer surgery after induction of general anesthesia in patients with ischemic stroke and its safety.Methods In this study,140 patients with ischemic stroke undergoing laparoscopic radical surgery for colorectal cancer between July 2023 and December 2023 in Tianjin People's Hospital were selected as the subjects.According to the random sampling method,they were divided into the control group(n=70)and the observation group(n=70).The patients in the control group were given conventional anesthesia and those in the observation group were given esketamine on the basis of conventional anesthesia.The incidence of post-induction hypotension(PIH)after anesthesia induction was recorded.Meanwhile,the mean arterial pressure(MAP)and heart rate(HR)were recorded before anesthesia induction(T0),before endotracheal intubation(T1),1 min after endotracheal intubation(T2),15 min after induction(T3),and 20 min after induction(T4).The adverse reaction rate was compared between the two groups.Results The PIH in the observation group was lower than that in the control group before intubation(T1)and after intubation(T2,T3,T4),and the differences were statistically significant(χ^(2)=4.766,3.897,3.962,4.743,all P<0.05).Comparison within the group showed that the observation group had the highest incidence of PIH at T1 and the lowest incidence at T4,while the control group had a significantly lower PIH incidence after endotracheal intubation compared to before,with statistical significance(P<0.05).For comparison with the baseline level of T0,the MAP and HR of the two groups were significantly reduced at T1,T2,T3,T4(P<0.05).At T1,T2,T3,and T4,the MAP of the observation group((84.1±12.0)mm Hg,(84.8±11.2)mm Hg,(85.0±11.8)mm Hg,(87.8±11.9)mm Hg)were higher than those of the control group((78.4±13.1)mm Hg,(80.8±12.8)mm Hg,(81.8±13.3)mm Hg,(83.0±14.5)mm Hg)(all P<0.05).The HR of the observation group was lower than that of the control group at T1((64.8±10.6)times·min^(-1) vs(65.6±12.6)times·min-1)),and the difference was statistically significant(P<0.05).There were no statistically significant differences of HR between the two groups at T0, T2, T3 and T4 (P>0.05). The incidence of severe bradycardia in the observation group was 4.3% (3/70), which was lower than that of 14.3% (10/70) in the control, and the difference was statistically significant ( χ^(2)=20.660, P<0.05). Conclusion In ischemic stroke, the application of esketamine helps to reduce the amount of propofol and maintain the hemodynamic stability of patients more effectively, thus reducing the risk of post-induction hypotension.
作者
谢淑华
曹家翔
杨涛
庞申月
耿立成
Xie Shu-hua;Cao Jia-xiang;Yang Tao;Pang Shen-yue;Geng Li-cheng(Department of Anesthesiology,Tianjin People’s Hospital,Tianjin 300121,China)
出处
《中国药物应用与监测》
CAS
2024年第3期280-283,共4页
Chinese Journal of Drug Application and Monitoring
基金
国家自然科学基金(82102248)。
