文章摘要
亚麻醉剂量艾司氯胺酮复合丙泊酚-瑞芬太尼在老年患者纤维支气管镜检查术中的应用
Application of subanesthetic dose of esketamine combined with propofol-remifentanil in elderly patients undergoing fiberoptic bronchoscopy
  
DOI：10.12089/jca.2022.12.006
中文关键词: 亚麻醉剂量  艾司氯胺酮  低血压  纤维支气管镜检查术  老年
英文关键词: Subanesthetic dose  Esketamine  Hypotension  Fiberoptic bronchoscopy  Aged
基金项目:广东省医学科学技术研究基金项目（A2019045）；佛山市卫健局医学科研课题（20190332）；佛山市“十三五”重点专科资助项目（FSZDZK135049）；佛山市杰出青年医学人才项目（600007）
作者单位E-mail
吕婷敏 528300,佛山市,南方医科大学顺德医院麻醉科  
彭祝丁 528300,佛山市,南方医科大学顺德医院麻醉科  
唐镇宇 528300,佛山市,南方医科大学顺德医院麻醉科  
万婷婷 528300,佛山市,南方医科大学顺德医院麻醉科  
邱文蕊 528300,佛山市,南方医科大学顺德医院麻醉科  
张奕文 528300,佛山市,南方医科大学顺德医院麻醉科  
陈汉文 528300,佛山市,南方医科大学顺德医院麻醉科 53918749@qq.com 
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中文摘要:
      
目的 探讨亚麻醉剂量艾司氯胺酮复合丙泊酚-瑞芬太尼在老年患者纤维支气管镜检查术中的应用效果。
方法 选择择期行纤维支气管镜检查术老年患者114例，年龄65～80岁，BMI 18～25 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：艾司氯胺酮组（E组）和对照组（C组），每组57例。麻醉诱导前E组静脉注射艾司氯胺酮0.2 mg/kg，C组给予等容量生理盐水，两组均在Marsh模式下靶控输注（TCI）丙泊酚效应室浓度3 μg/ml，Minto模型TCI瑞芬太尼效应室浓度4 ng/ml，入镜后调整丙泊酚和瑞芬太尼效应室浓度分别为1.5～3 μg/ml和2～4 ng/ml。记录入室后安静10 min（T0）、睫毛反射消失时（T1）、至声门时（T2）、至隆突时（T3）、术毕时（T4）、拔除喉罩时（T5）的HR、MAP、SpO2和Narcotrend指数（NI）。记录术中丙泊酚和瑞芬太尼用量。记录呛咳、支气管痉挛、低血压、低氧血症、术后咽痛等不良反应发生情况。
结果 与T0时比较，T1时E组HR明显增快，MAP明显升高（P＜0.05）；T1时C组HR明显减慢，MAP明显降低（P＜0.05），T2、T3时C组MAP明显升高（P＜0.05）。与C组比较，E组低血压发生率明显降低，丙泊酚、瑞芬太尼用量明显减少，呛咳、支气管痉挛和术后咽痛发生率明显降低（P＜0.05）。
结论 亚麻醉剂量（0.2 mg/kg）艾司氯胺酮复合TCI丙泊酚-瑞芬太尼可安全有效地用于老年患者纤维支气管镜检查术，可减少丙泊酚与瑞芬太尼用量，且血流动力学平稳，不良反应少。
英文摘要:
      
Objective To investigate the effect of esketamine combined with propofol-remifentanil in elderly patients undergoing fiberoptic bronchoscopy.
Methods A total of 114 elderly patients, aged 65-80 years, BMI 18-25 kg/m2, ASA physical status Ⅱ or Ⅲ, scheduled for fiberoptic bronchoscopy were selected. The patients were divided into two groups by random number table: esketamine group (group E) and control group (group C), 57 patients in each group. During anesthesia induction, group E was given esketamine 0.2 mg/kg intravenously, and group C was given equal volume normal saline. Under Marsh mode, the concentration of propofol effect chamber in target controlled infusion (TCI) was 3 μg/ml, and the concentration of remifentanil effect chamber in Minto model was 4 ng/ml. After the fiberoptic bronchoscope entered, the effect chamber concentrations of propofol and remifentanil were adjusted to 1.5-3 μg/ml and 2-4 ng/ml respectively. HR, MAP, SpO2, and Narcotrend index (NI) were also recorded at following time points: after the patient entered the room was quiet for 10 minutes (T0), the time of eyelash reflex disappeared (T1), the time when fibrobronchoscope reaching glottis (T2), the time when fibrobronchoscope reaching carina (T3), end of the surgery (T4), after extubation (T5). The dosage of propofol and remifentanil were recorded. The adverse reactions including cough, bronchospasm, hypotension, hypoxemia, postoperative throat sore were recorded.
Results Compared with T0, HR and MAP in group E were increased significantly at T1(P < 0.05), HR and MAP in group C were decreased significantly at T1(P < 0.05), and MAP in group C was increased significantly at T2 and T3(P < 0.05). Compared with group C, the incidence of hypotension in group E was lower, and the dosage of propofol and remifentanil was decreased significantly (P < 0.05). Compared with group C, the incidence of cough, bronchospasm and postoperative throat sore in group E decreased significantly (P < 0.05).
Conclusion Subanesthetic dose of esketamine (0.2 mg/kg) combined with TCI propofol-remifentanil can be safely and effectively used for fiberoptic bronchoscopy in elderly patients, which can reduce the dosage of propofol and remifentanil, and also have stable hemodynamics and few adverse reactions.
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