摘要: |
目的 研究艾司氯胺酮用于无肌松插管,对诱导后低血压发生率的影响。方法 纳入2021年11月8日至2022年2月18日188名接受术中神经电生理监测的甲状腺切除术患者,将患者随机分为艾司氯胺酮组(K组)(n=94)及异丙酚组(P组)(n=94)。记录插管前(T1:全部诱导药物后注射后30s)以及插管后间隔1分钟(T2-T6)的平均动脉压的变化;比较在T1时间点,两组方案诱导后低血压(post induction hypotension,PIH)发生率的差异。结果 两组患者的临床特征具有可比性。插管前PIH发生率分别为艾氯胺酮组31.5%、异丙酚组79.8% (P<0.001)。在所有观察的时间点,艾司氯胺酮组PIH发生率均显著低于异丙酚组(P<0.001)。两组患者MAP较基线显著降低(F=256.78, P<0.001)。异丙酚组MAP下降幅度大于艾司氯胺酮组(F=17.53, P<0.001)。K组患者插管条件满意为31例(33.7%),P组为88例(93.6%),K组患者插管条件良好61例(66.3%),P组6例(6.4%)(P<0.001)。结论 采用艾司氯胺酮1mg/kg、瑞芬太尼4mcg/kg、异丙酚0.5mg/kg的诱导方案进行无肌松插管可降低PIH的发生率,并提供临床可接受的插管条件。 |
关键词: 艾司氯胺酮 诱导后低血压 无肌松插管 甲状腺切除术 |
DOI:10.12025/j.issn.1008-6358.2023.20230537 |
分类号:R 614 |
基金项目:复旦大学附属中山医院青年基金(2021ZSQN45) |
|
Effect of using esketamine for endotracheal intubation without muscle relaxants on post-induction hypotension |
YE Zhi-xiang1, SHI Yun-cen2, HUANG Ning2, ZHANG Xiao-guang2, HUANG Yong2, DU Fang2
|
1.Zhongshan Hospital (Xiamen), Fudan University;2.Zhongshan Hospital, Fudan University
|
Abstract: |
Objective Research the effect of using esketamine for endotracheal intubation without muscle relaxants on post-induction hypotension. Methods From November 8st, 2021 to February 18st, 2022, We enrolled 188 adult patients undergoing thyroidectomy under intraoperative electromyographic monitor,Patients were randomly allocated into esketamine group (Group K,n=94)or propofol group (Group P,n=94).Primary outcome was the occurrence of PIH before intubation (T1, 30s after all induction agents injection). Mean arterial pressure (MAP) was recorded before intubation (T1) and at 1-minute interval for 5 minutes (T2-T6) after endotracheal intubation. Results Patients in both groups had comparable clinical characteristics. The incidence of PIH before intubation was 31.5% for esketamine group and 79.8% for propofol group (P<0.001). MAP significantly decreased compared with the baseline in both groups (Fig.2, F=256.78, P<0.001). The decrease of MAP in propofol group was greater than that in esketamine group (F=17.53, P<0.001). Excellent intubation conditions were 31 (33.7 %) in group K and 88 (93.6%) in group P, while good intubation conditions were 61 (66.3 %) in group K and 6 (6.4%) in group P (P<0.001). Conclusion Induction with esketamine 1mg/kg, remifentanil 4mcg/kg and propofol 0.5mg/kg can reduce the incidence of PIH with clinically acceptable intubation condition for endotracheal intubation without muscle relaxants. |
Key words: Esketamine, Post-induction hypotension, Endotracheal intubation without muscle relaxants, thyroidectomy |