目的 评价三种以艾司氯胺酮为基础的复合麻醉方案对模拟野战环境下幼猪苏醒质量与可控性的影响。方法 将24头健康幼猪随机分为三组(n=8):A组,右美托咪定(5 μg/kg)+咪达唑仑(0.3 mg/kg)+艾司氯胺酮(3 mg/kg);B组,咪达唑仑(0.3 mg/kg)+艾司氯胺酮(3 mg/kg);C组,右美托咪定(5 μg/kg)+艾司氯胺酮(3 mg/kg)。所有药物均经肌肉注射给药。在模拟野战环境下实施麻醉,评估气管插管条件,对条件不满意的B、C组追加吸入七氟醚后完成气管插管,随后行剖腹探查与脾切除术,记录诱导时间、麻醉维持期生命体征、停药后苏醒时间,并采用改良苏醒质量评分与可控性评分进行评估。结果 A组无需七氟醚辅助,插管满意率为100%,显著高于B组(0%)和C组(12.5%),差异有统计学意义(P<0.05)。A组诱导平稳,镇静与肌松效果最佳,B组诱导平稳,但苏醒时间最长。C组苏醒最快,但苏醒期兴奋发生率(62.5%)显著高于A组和B组,差异有统计学意义(P<0.05)。A组苏醒质量总评分(4.5±0.6)分最高,与B组(3.1±0.8)分、C组(2.8±1.1)分相比,差异具有统计学意义(P<0.05)。A组可唤醒测试,睁眼和抬头的例数明显多于B组和C组,与A组比较,C组苏醒期表现为挣扎的例数较多,差异均有统计学意义(P<0.05)。结论 在模拟野战环境下,A组方案能可靠提供气管插管条件,在保证麻醉深度的同时,提供最佳的苏醒平稳性与可控性,是一种高质量、高效率麻醉方案。
Abstract
Objective To evaluate the effects of three esketamine-based combined anesthesia schemes on the recovery quality and controllability of piglets under simulated field environment. Methods Twenty-four healthy piglets were randomly divided into three groups (n=8). Group A: dexmedetomidine (5 μg/kg)+midazolam (0.3 mg/kg) + esketamine (3 mg/kg), Group B: midazolam (0.3 mg/kg) + esketamine (3 mg/kg), Group C: dexmedetomidine (5 μg/kg) + esketamine (3 mg/kg). All drugs were administered via intramuscular injection. Anesthesia was performed in a simulated field environment, and tracheal intubation conditions were evaluated. For Groups B and C with unsatisfactory conditions, sevoflurane inhalation was added before tracheal intubation, followed by laparotomy and splenectomy. The induction time, vital signs during anesthesia maintenance, and recovery time after drug withdrawal were recorded, and the recovery quality and controllability were evaluated using the modified recovery quality score and controllability score. Results Group A required no sevoflurance assistance, with a 100% satisfaction rate for intubation, significantly higher than that in Group B (0%) and Group C (12.5%) , and the difference was statistically significant (P<0.05). Group A had smooth induction and the best sedative and muscle relaxant effects. Group B also had smooth induction but the longest recovery time. Group C exhibited the fastest recovery, but the incidence of excitement during the recovery period (62.5%) was significantly higher than that in Group A and Group B, and the difference was statistically significant (P<0.05). The total recovery quality score of Group A was highest (4.5±0.6), with statistically significant differences compared with Groups B(3.1±0.8) and Group C(2.8±1.1)(P<0.05). The awake test of Group A showed significantly more cases of eye opening and head turning than Group B and Group C. Compared with Group A, Group C showed more cases of struggling during the recovery period, and the differences were statistically significant (P<0.05). Conclusions Under simulated field environment, the Group A scheme can reliably provide tracheal intubation conditon, ensuring adequate anesthesia depth while providing the best recovery stability and controllability, which is a high-quality and efficient anesthesia protocol.
关键词
野战麻醉 /
苏醒质量 /
气管插管 /
右美托咪定 /
艾司氯胺酮 /
咪达唑仑 /
脾切除术 /
猪
Key words
field anesthesia /
recovery quality /
tracheal intubation /
dexmedetomidine /
esketamine /
midazolam /
splenectomy /
pig
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参考文献
[1] Sullivan T P, Eaglstein W H, Davis S C, et al. The pig as a model for human wound hea ling[J]. Wound Repair Regen,2001,9(2):66-76.
[2] Butler F K.Tactical combat casualty care:update 2009[J].J Trauma,2010,69(1 Suppl):10-13.
[3] 杨 春,刘寒玉,刘存明.艾司氯胺酮的临床应用进展[J].临床麻醉学杂志,2023,39(4):414-417.
[4] Li L,Vlisides P E. Ketamine:50 years of modulating the mind[J]. Front Hum Neurosci,2016,10:612.
[5] 郭仁浜, 林冠文, 高 伟, 等.艾司氯胺酮在围术期多模式镇痛中的研究进展[J]. 临床麻醉学杂志, 2025,41(12):1319-1325.
[6] Weerink M A S, Struys M M R F, Hannivoort L N, et al. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine[J]. Clin Pharmacokinet, 2017,56(8):893-913.
[7] 赖思旭,闵 苏.右美托咪定不同给药途径对患者术后恢复影响的研究进展[J]. 临床麻醉学杂志, 2024,41(6):644-647.
[8] Griffin C E, Kaye A M, Bueno F R, et al. Benzodiazepine pharmacology and central nervous system-mediated effects[J].Ochsner J, 2013,13(2):214-223.
[9] 王 希,武 寅,林 芳, 等.野战医疗队检验模块规范化训练的需求、对策与建议[J].武警医学, 2025, 36 (10):164-166.
[10] 鞠衍馨, 张 丽, 于梅杰.野战条件下动物模拟手术麻醉体会[J].海军军医杂志,2022,43(2):208-209.
[11] 李俊锋.陈冬妮,窦心怡,等.舒泰复合右美托咪定两种给药方案对巴马小型猪麻醉效果观察[J].中国畜牧兽医,2024,51(7):3206-3214.
[12] 沈亚萍,李丽伟,吴俊鹤,等.艾司氯胺酮联合右美托咪定对环状脱垂痔切除术患者术后睡眠和恢复质量的影响[J].临床麻醉学杂志,2024,40(12):1241-1245.
[13] Li S,Zhou W,Li P,et al.Effects of Ketamine and esketamine on preventing postpartum depression after cesarean delivery:a meta-analysis[J].J Affect Disord,2024,351:720-728.
[14] Dehbozorgi M, Fereidooni F, Bozorgmehr R, et al. Dexmedetomidine administration as a possible cognitive enhancer through increasing the level of brain-derived neurotrophic factors in surgical patients:a systematic review and meta-analysis[J]. BMC Anesthesiol,2024,24(1):256.
[15] Su X, Meng Z,Wu X, et al.Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery:a randomized, double-blind, placebo-controlled trial[J]. Lancet,2016,388(10054):1893-1902.
[16] 冷 燕,代 娜,乔芊芊,等.小型猪气管插管时异氟烷半数有效剂量的探索[J].中国实验动物学报, 2024, 32(8):1039-1044.
[17] 张加强,张 卫.艾司氯胺酮临床应用专家共识[J].临床麻醉学杂志,2022, 38(10):1094-1098.
[18] 吴新民,许 幸,王俊科,等. 右美托咪定用于全身麻醉诱导和维持的专家共识(2023版)[J].中华麻醉学杂志,2023,43(11):1281-1288.
[19] 王 云,岳 云.右美托咪定联合艾司氯胺酮在腹腔镜手术麻醉中的临床应用[J]. 临床麻醉学杂志, 2021,37(5):466-469.
[20] Borentain S, Daly E J, Turkoz I, et al. Sleep disturbance and efficacy of esketamine nasalspray in patients with treatment-resistant depression:findings from randomized,controlled trials[J].Neuropsychopn armacology, 2021,46(1):109-115.
[21] Wen Y, Xu J, Shen J,et al.Esketamine prevents postoperative emotional and cognitive dysfunction by suppressing microglial M1 polarization and regulating the BDNF-TrkB pathway in ageing rats with preoperatitrave sleep disturbance[J]. Mol Neurobiol,2024,61(8):5680-5698.
[22] Wang X, Lin C, Lan L, et al. Perioperative intravenous sketamine for acute postoperative pain in adults:a systematic review and meta-analysis[J].J Clin Anesth,2021,68:110071.
[23] Chen H Z, Gao Y,Li K K, et al. Effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section[J].World J Clin Cases, 2024,12(28):6195-6203.
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