艾司氯胺酮联合右美托咪定在老年去阿片化麻醉诱导中的应用

李冰清; 史思仁; 黄常君; 吴美华

doi:10.16766/j.cnki.issn.1674-4152.003960

艾司氯胺酮联合右美托咪定在老年去阿片化麻醉诱导中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003960

杭州市临平区第一人民医院麻醉科，浙江杭州 311100

基金项目:

浙江省医药卫生科技计划项目 2024KY270

中国红十字基金会医学赋能公益专项基金“医学赋能及人才培养计划”临床科研项目 2022452

杭州市医药卫生科技项目 B20240136

详细信息

通讯作者:
史思仁，E-mail：15925626688@163.com

中图分类号: R614.2 R656
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出版历程
- 收稿日期: 2024-07-11
- 网络出版日期: 2025-06-30

Application of opioid-free anesthesia combined with Esketamine in elderly laparoscopic surgery

Department of Anesthesiology, the First People' s Hospital of Linping District, Hangzhou, Zhejiang 311100, China

摘要

摘要: 目的探讨艾司氯胺酮联合右美托咪定在老年去阿片化麻醉诱导中的应用效果，分析其对接受腹腔镜手术治疗的老年患者血流动力学的影响。方法选择2022年4—7月于杭州市临平区第一人民医院接受腹腔镜手术治疗的60例老年患者为研究对象，采用随机数字表法分为去阿片化麻醉(OFA组，30例，接受去阿片化麻醉)和基于阿片类药物麻醉组(OBA组，30例，接受常规阿片化麻醉)。比较2组血流动力学、术中镇静指数、静息与运动的不同时间VAS和Rasmay得分、不良反应发生率。结果 OFA组术后拔管时间和麻醉恢复室停留时间长于OBA组(P＜0.05)；麻醉诱导后(T1)、气管插管后(T2)、切皮时(T3)、气腹开始时(T4)、气腹结束后5 min(T5)OFA组心率均高于OBA组(P＜0.05)；T2~T5时间点OFA组平均动脉压低于OBA组(P＜0.05)；T2~T3时间点OFA组脑电双频指数高于OBA组，T4~T5时间点OFA组脑电双频指数低于OBA组(P＜0.05)；术后30 min OFA组Rasmay评分高于OBA组(P＜0.05)，术毕以及术后30 min OFA组VAS评分低于OBA组(P＜0.05)；OFA组恶心呕吐发生2例(6.67%)，低于OBA组的8例(26.67%，χ²=4.320，P=0.038)。结论将去阿片化麻醉用于接受腹腔镜手术治疗的老年患者中，能更好地维持血流动力学稳定，减少术后不良反应的发生，并且能发挥术后的镇静镇痛作用。
- 老年腹腔镜手术 /
- 艾司氯胺酮 /
- 去阿片化麻醉 /
- 右美托咪定 /
- 镇静镇痛 /
- 血流动力学
Abstract: Objective To explore the application effect of esketamine combined with dexmedetomidine in the induction of opioid anesthesia in elderly patients, and to analyze its influence on their hemodynamics during laparoscopic surgery. Methods In the period spanning April to July 2022, a total of 60 elderly patients who underwent laparoscopic surgery at the First People' s Hospital of Linping District in Hangzhou were methodically divided into two groups. This division was conducted through the utilization of a random number table method, with 30 patients in the opioid-based anesthesia (OBA) group receiving conventional opioid anesthesia and the remaining 30 patients in the opioid-free anesthesia (OFA) group receiving de-opioid anesthesia. The hemodynamics, intraoperative sedation index, visual analogue scale (VAS) and Rasmay scores at varying times of rest and exercise, and the incidence of adverse reactions were then compared between the two groups. Results Post-operative extubation time and postanest-hesia care unit (PACU) stay time in the OFA group were found to be significantly found to be significantly longer than those in the OBA group (P < 0.05); this was the case at the following time points: after anesthesia induction (T1), after tracheal intubation (T2), at skin incision (T3), at the beginning of pneumoperitoneum (T4), and 5 minutes after pneumoperitoneum (T5). Heart rate (HR) in the OFA group was higher than that in the OBA group (P < 0.05); mean arterial pressure (MAP) in the OFA group at T2-T5 was lower than that in the OBA group (P < 0.05); bispectral index (BIS) index in the OFA group at T2-T3 was higher than that in the OBA group at T4-T5 was lower than that in the OBA group (P < 0.05); Rasmay score in the OFA group was higher than that in the OBA group at 30 min after surgery (P < 0.05). The VAS score in the OFA group was lower than that in the OBA group at the end of surgery and 30 min after surgery (P < 0.05). Nausea and vomiting occurred in 2 cases in the OFA group (6.67%) compared to 8 cases in the OBA group (26.67%, χ²=4.320, P=0.038). Conclusion The use of opioid anesthesia in elderly patients undergoing laparoscopic surgery may better maintain hemodynamic stability, reduce postoperative adverse events, and play a role in postoperative sedation and analgesia.
- Elderly laparoscopic surgery /
- Esketamine /
- De-opioid anesthesia /
- Dexmedetomidine /
- Sedation and analgesia /
- Hemodynamics

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表 1 2组接受腹腔镜手术治疗的老年患者一般资料比较

Table 1. Comparison of general information between two groups of elderly patients treated by laparoscopic surgery

组别	例数	年龄(x±s，岁)	性别[例(%)]		ASA分级[例(%)]			BMI(x±s)	麻醉时间(x±s，min)	手术时间(x±s，min)	基础疾病[例(%)]
组别	例数	年龄(x±s，岁)	女性	男性	Ⅰ级	Ⅱ级	Ⅲ级	BMI(x±s)	麻醉时间(x±s，min)	手术时间(x±s，min)	高血压	糖尿病	高脂血症
OBA组	30	68.08±5.03	11(36.67)	19(66.33)	8(26.67)	15(50.00)	7(23.33)	22.73±2.73	55.24±10.34	48.31±12.34	12(40.00)	9(30.00)	13(43.33)
OFA组	30	70.46±8.26	15(50.00)	15(50.00)	10(33.33)	15(50.00)	5(16.67)	23.80±1.14	61.37±14.69	48.37±15.24	10(33.33)	7(23.33)	8(26.67)
统计量		1.348^a	1.086^b		0.671^c			1.981^a	1.869^a	0.017^a	0.287^b	0.341^b	1.832^b
P值		0.184	0.300		0.502			0.055	0.067	0.987	0.592	0.559	0.176
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 2组接受腹腔镜手术治疗的老年患者不同时间点HR、MAP比较(x±s，次/min)

Table 2. Comparison of HR and MAP between two groups of elderly patients undergoing laparoscopic surgery at different time (x±s, times/min)

组别	例数	HR
组别	例数	T0	T1	T2	T3	T4	T5
OFA组	30	76.34±10.25	78.89±11.35	79.48±10.35	76.87±12.34	74.34±11.58	77.39±11.64
OBA组	30	74.37±11.34	64.12±11.24^a	61.34±9.21^a	58.34±11.02^a	66.01±10.21^a	70.31±10.34^a
F值		0.706	5.064	7.171	6.135	2.955	2.491
P值		0.483	＜0.001	＜0.001	＜0.001	0.005	0.016

组别	例数	MAP
组别	例数	T0	T1	T2	T3	T4	T5
OFA组	30	89.27±12.27	87.11±10.37	89.03±6.54	86.94±8.27	87.62±6.52	88.11±5.39
OBA组	30	89.36±12.41	85.22±10.97^a	102.32±12.03^a	95.22±12.62^a	92.87±10.25^a	89.71±11.28^a
F值		0.028	0.323	4.116	3.369	4.171	3.330
P值		0.978	0.748	＜0.001	0.001	＜0.001	0.002
注：与T0时比较，^aP＜0.05。HR，F_时间=7.611，P=0.008；F_组别=130.206，P＜0.001；F_交互=7.122，P=0.010。MAP，F_时间=98.663, P＜0.001；F_组别=39.637, P＜0.001；F_交互=6.067, P=0.017。

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表 3 2组接受腹腔镜手术治疗的老年患者术中BIS指数比较(x±s)

Table 3. Comparison of BIS index between two groups of elderly patients undergoing laparoscopic surgery (x±s)

组别	例数	BIS
组别	例数	T0	T1	T2	T3	T4	T5
OFA组	30	94.54±4.57	52.14±4.35^a	55.69±5.87^ab	57.59±6.37^ab	70.98±6.53^ab	74.37±5.38^ab
OBA组	30	95.34±3.97	50.31±3.27^a	51.34±3.64^ab	51.78±4.38^ab	78.28±7.68^ab	79.34±6.12^ab
F值		1.629	1.842	3.450	4.116	3.966	3.341
P值		0.109	0.071	0.001	＜0.001	＜0.001	0.001
注：与T0时比较，^aP＜0.05；与T1时比较，^bP＜0.05。F_时间=288.320，P＜0.001；F_组别=114.727，P＜0.001；F_交互=68.751，P＜0.001。

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表 4 2组接受腹腔镜手术治疗的老年患者静息与运动的不同时间Rasmay评分和VAS评分比较(x±s，分)

Table 4. Comparison of Rasmay and VAS scores at various rest and exercise time points between two groups of elderly patients undergoing laparoscopic surgery (x±s, points)

组别	例数	Rasmay
组别	例数	术毕	术后30 min	术后2 h	术后4 h	术后8 h
OFA组	30	2.87±0.69	3.08±1.02	3.18±1.12	3.09±0.57	3.12±1.02
OBA组	30	2.74±0.71	2.22±0.62	3.19±1.12	3.08±1.62	3.18±1.12
t值		0.824	2.271	0.035	0.833	0.217
P值		0.412	0.025	0.973	0.407	0.829

组别	例数	VAS
组别	例数	术毕	术后30 min	术后2 h	术后4 h	术后8 h
OFA组	30	1.31±0.52	1.39±0.67	0.58±0.11^a	2.49±0.67^a	3.05±0.84^a
OBA组	30	2.22±0.97	2.29±1.02	0.62±0.12^a	2.53±0.58^a	3.35±0.92^a
t值		4.529	4.039	1.346	0.247	1.319
P值		＜0.001	＜0.001	0.184	0.806	0.192
注：Rasmay评分，F_时间=46.122，P＜0.001；F_组别=24.268，P＜0.001；F_交互=5.364，P=0.024。VAS评分，F_时间=69.734，P＜0.001；F_组别=5.234，P=0.026；F_交互=38.953，P＜0.001。与术毕时比较, ^aP＜0.05。

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表 5 2组接受腹腔镜手术治疗的老年患者手术一般情况比较(x±s，min)

Table 5. Comparison of the general information between two groups of elderly patients undergoing laparoscopic surgery (x±s, min)

组别	例数	麻醉苏醒时间	术后拔管时间	PACU停留时间
OFA组	30	10.96±2.58	7.68±0.32	26.35±1.35
OBA组	30	9.78±2.69	7.24±0.45	25.36±2.18
t值		1.734	4.365	2.115
P值		0.088	＜0.001	0.040

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