[1]周 强,裴小英,匡龙祝,等.亚麻醉剂量艾司氯胺酮联合咪达唑仑对老年全麻手术患者血流动力学和术后谵妄发生的影响[J].陕西医学杂志,2024,(2):243-246,261.[doi:DOI:10.3969/j.issn.1000-7377.2024.02.021]
　ZHOU Qiang,PEI Xiaoying,KUANG Longzhu,et al.Effect of sub-anesthetic dose of esketamine combined with midazolam on hemodynamics and incidence of postoperative delirium in elderly patients undergoing general anesthesia surgery[J].,2024,(2):243-246,261.[doi:DOI:10.3969/j.issn.1000-7377.2024.02.021]
点击复制

亚麻醉剂量艾司氯胺酮联合咪达唑仑对老年全麻手术患者血流动力学和术后谵妄发生的影响
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2024年2期
页码:
243-246,261
栏目:
药物与临床
出版日期:
2024-02-05

文章信息/Info

Title:
Effect of sub-anesthetic dose of esketamine combined with midazolam on hemodynamics and incidence of postoperative delirium in elderly patients undergoing general anesthesia surgery
作者:
周 强; 裴小英; 匡龙祝; 廖 英; 朱泉玉; 胡海燕
(成都西区医院麻醉科,四川 成都 610036)
Author(s):
ZHOU Qiang; PEI Xiaoying; KUANG Longzhu; LIAO Ying; ZHU Quanyu; HU Haiyan
(Department of Anesthesiology,Chengdu Western Hospital,Chengdu 610036,China)
关键词:
艾司氯胺酮;  咪达唑仑;  老年人;  全麻手术;  血流动力学;  术后谵妄
Keywords:
Esketamine;  Midazolam;  Aged;  General anesthesia surgery;  Hemodynamics;  Postoperative delirium
分类号:
R 614.2
DOI:
DOI:10.3969/j.issn.1000-7377.2024.02.021
文献标志码:
A
摘要:
目的:探讨亚麻醉剂量艾司氯胺酮联合咪达唑仑对老年全麻手术患者血流动力学和术后谵妄(POD)发生的影响。方法:选取老年髋关节置换术患者96例,根据信封法将其随机分为联合组和对照组,各48例。两组患者予以相同麻醉方法,联合组在手术结束前及静脉自控镇痛(PCIA)药物中加用艾司氯胺酮。比较两组患者血流动力学指标、手术指标、炎症因子水平、POD和不良反应发生率。结果:联合组手术结束前20 min心率和平均动脉压均明显低于对照组(均P<0.05); 联合组苏醒时间、拔管时间均少于对照组(均P<0.05); 联合组术后C反应蛋白和白介素-6水平明显低于对照组(均P<0.05); 联合组POD发生率明显低于对照组(P<0.05)。结论:亚麻醉剂量艾司氯胺酮联合咪达唑仑应用于老年全麻手术患者,有利于维持血流动力学稳定,缩短苏醒时间,降低POD发生率,控制机体炎性反应。
Abstract:
Objective:To investigate the effect of sub-anesthetic dose of esketamine combined with midazolam on hemodynamics and the incidence of postoperative delirium(POD)in elderly patients undergoing general anesthesia surgery.Methods:A total of 96 elderly patients who underwent hip replacement surgery were selected.They were randomly divided into the combination group and the control group by the envelope method,with 48 patients in each group.The patients in the two groups were treated with the same anesthesia method,while those in the combination group were additionally treated with esketamine before the end of surgery and in intravenous patient-controlled analgesia(PCIA).Hemodynamic indicators,surgical indicators,inflammatory factor levels,and the incidence rates of POD and adverse reactions were compared between the two groups.Results:Heart rate and mean arterial pressure of the combination group at 20 min before the end of surgery were significantly lower than those of the control group(all P<0.05).Wake-up time and extubation time of the combination group were shorter than those of the control group(all P<0.05).After operation,the levels of C-reactive protein and interleukin-6 in the combination group were significantly lower than those in the control group(all P<0.05).The incidence of POD in the combination group was significantly lower than that in the control group(P<0.05).Conclusion:Applying sub-anesthetic dose of esketamine combined with midazolam to elderly patients undergoing general anesthesia surgery is beneficial to maintain hemodynamic stability,shorten wake-up time,reduce the incidence of POD,and control inflammatory response.

参考文献/References:

[1] MOHSENI S,JOSEPH B,PEDEN C J.Mitigating the stress response to improve outcomes for older patients undergoing emergency surgery with the addition of beta-adrenergic blockade[J].Eur J Trauma Emerg Surg,2022,48(2):799-810.
[2] 王天龙,王东信,李金宝,等.中国老年患者围手术期麻醉管理指导意见(2020版)(一)[J].中华医学杂志,2020,100(31):2404-2415.
[3] 彭赛,熊武.针刺联合全麻对老年腹部手术患者苏醒期躁动、应激反应及术后认知功能的影响[J].陕西中医,2021,42(4):517-519.
[4] 焦志华,陈军,范坤,等.不同麻醉方法对老年患者膝关节置换术后认知功能的影响[J].陕西医学杂志,2020,49(3):317-320.
[5] 王中玉,李娟,王安琪,等.亚麻醉剂量艾司氯胺酮对行膝关节置换术老年患者麻醉诱导期间血流动力学和应激反应的影响[J].中华实用诊断与治疗杂志,2022,36(1):88-92.
[6] 冯江,黄太满,王晓霞.不同剂量咪达唑仑联合右美托咪定对早中期非小细胞肺癌患者麻醉及苏醒质量影响[J].创伤与急危重病医学,2021,9(5):397-399.
[7] 高宇晨,王越夫,王剑辉,等.精准麻醉对心血管手术患者术后谵妄的影响[J].临床麻醉学杂志,2020,36(11):1082-1085.
[8] 赵以林,罗爱林.2018版美国麻醉医师协会适度镇静和镇痛指南解读[J].临床外科杂志,2019,27(1):24-28.
[9] 李娟,邹义壮,冯锋,等.谵妄评定方法修订及其信度、效度测试[J].临床精神医学杂志,2003,13(3):147-149.
[10] 霍奇帆,赵静,郭建伟,等.纳布啡对插入喉罩时最低丙泊酚有效血浆质量浓度的影响[J].西北药学杂志,2022,37(4):117-121.
[11] BOAVISTA B H L,LEME S P,FERREIRA C F,et al.Immunomodulatory effects of anesthetic agents in perioperative medicine[J].Minerva Anestesiol,2020,86(2):181-195.
[12] MARGRAF A,LUDWIG N,ZARBOCK A,et al.Systemic inflammatory response syndrome after surgery:Mechanisms and protection[J].Anesth Analg,2020,131(6):1693-1707.
[13] EVERED L A,CHAN M T V,HAN R,et al.Anaesthetic depth and delirium after major surgery:A randomised clinical trial[J].Br J Anaesth,2021,127(5):1704-712.
[14] DUNING T,ILTING-REUKE K,BECKHUIS M,et al.Postoperative delirium-treatment and prevention[J].Curr Opin Anaesthesiol,2021,34(1):27-32.
[15] GOLDBERG T E,CHEN C,WANG Y,et al.Association of delirium with long-term cognitive decline:A meta-analysis[J].JAMA Neurol,2020,77(11):1373-1381.
[16] 卢钊楷,刘卫锋,陈醒霞,等.结直肠癌腹腔镜手术患者超声引导下不同浓度罗哌卡因腰方肌阻滞的围术期镇痛效果及T淋巴细胞亚群变化[J].山东医药,2021,61(33):34-39.
[17] 姚琳,杨帅.硬膜外阻滞联合全身麻醉对老年结直肠癌患者围术期免疫功能及胃肠功能影响的临床研究[J].陕西医学杂志,2022,51(4):449-453.
[18] 阮倩,自华芬,陈莉.右美托咪定与罗哌卡因腰硬联合麻醉对老年下肢骨折患者围术期血流动力学、麻醉恢复质量及镇痛效果的影响[J].川北医学院学报,2021,36(8):1068-1071.
[19] 吴仁庆.电针联合全身麻醉对腹部手术患者镇痛效果及血清IL-1β、S100β蛋白和NSE水平的影响[J].陕西中医,2021,42(1):118-120.
[20] 杨子健,黄铭颖,刘湘钰,等.艾司氯胺酮复合咪达唑仑对老年髋关节置换术后谵妄的影响及对HT22细胞的作用[J].实用医学杂志,2022,38(19):2395-2399.
[21] 张忠其,许亚菲,张艳静,等.丙泊酚复合小剂量艾司氯胺酮抑制胃镜置入反应的有效剂量[J].临床麻醉学杂志,2021,37(9):949-952.
[22] 吕婷敏,彭祝丁,唐镇宇,等.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[J].临床麻醉学杂志,2022,38(12):1264-1268.
[23] 陈文道.低剂量艾司氯胺酮对腹腔镜胆囊切除术麻醉效果和血清炎症因子的影响[J].中国实验诊断学,2022,26(9):1295-1299.
[24] 赵鑫鑫,周翠红,董海龙,等.艾司氯胺酮对慢性可变应激小鼠抑郁样行为及前额叶皮质鞘脂水平的影响[J].空军军医大学学报,2023,44(4):294-300,284.
[25] 孙艳,霍文文,金晓菲.艾司氯胺酮预处理对臂丛神经阻滞老年手术患者术后疼痛循环呼吸及炎症因子的影响[J].中华老年医学杂志,2021,40(12):1546-1550.

相似文献/References:

[1]赵 娟,陈金权.瑞马唑仑对老年大鼠海马B淋巴细胞瘤-2、一氧化氮合酶蛋白表达及神经元凋亡和认知功能的影响[J].陕西医学杂志,2022,51(3):289.[doi:DOI:10.3969/j.issn.1000-7377.2022.03.006]
　ZHAO Juan,CHEN Jinquan.Effects of remazolam on Bcl-2 and NOS protein expression, neuronal apoptosis and cognitive function in hippocampus of aged rats[J].,2022,51(2):289.[doi:DOI:10.3969/j.issn.1000-7377.2022.03.006]
[2]穆华颖,崔允巍,蒋璐璐,等.艾司氯胺酮复合盐酸纳布啡对高龄肥胖孕妇剖宫产术后镇痛效果及产后抑郁的影响[J].陕西医学杂志,2024,(8):1097.[doi:DOI:10.3969/j.issn.1000-7377.2024.08.020]

备注/Memo

备注/Memo:
基金项目:四川省卫生和计划生育委员会科研项目(20PJ572)
更新日期/Last Update: 2024-02-05