目的 探讨小剂量艾司氯胺酮与苯磺酸瑞马唑仑联合用于肩袖修复术患者的麻醉效果及对相关指标的影响。方法 选取2022-07至2023-07在山西医科大学第二医院接受关节镜下肩袖修复术的患者80例,采用随机数字表法分为观察组和对照组,每组40例。观察组麻醉诱导采取舒芬太尼、罗库溴铵、依托咪酯和小剂量艾司氯胺酮,瑞马唑仑与瑞芬太尼维持;对照组采取舒芬太尼、罗库溴铵、依托咪酯麻醉诱导,瑞芬太尼与丙泊酚维持。观察两组血流动力学参数、自主呼吸恢复时间、苏醒时间、术后6、12 h视觉模拟评分法(VAS)评分、Ricker镇静-躁动评分、应激反应指标、麻醉相关不良反应。结果 麻醉后,观察组收缩压[(112.75±12.59)mmHg]、舒张压[(70.87±6.95)mmHg]、心率[(71.45±7.63)次/min],高于对照组收缩压[(98.37±12.77)mmHg]、舒张压[(65.57±7.46)mmHg]、心率[(71.35±6.38)次/min],差异均有统计学意义(P＜0.05);观察组苏醒时间[(4.63±4.72)min]、自主呼吸恢复时间[(5.39±0.92)min]短于对照组苏醒时间(5.29±0.44)min、自主呼吸恢复时间[(8.23±1.34)min];Ricker镇静-躁动评分、术后6 hVAS评分低于对照组(P<0.05);观察组术后的皮质醇、肾上腺素、促肾上腺皮质、丙二醛均低于对照组,术后超氧化物歧化酶高于对照组,术后不良反应发生率低于对照组,差异均有统计学意义(P<0.05)。结论 在肩袖修复术中采用小剂量艾司氯胺酮联合瑞马唑仑用于手术麻醉,可维持血流动力学稳定,改善患者苏醒质量,降低应激反应,降低麻醉相关不良反应的发生率。
Abstract
Objective To investigate the anesthetic effect of low-dose esketamine combined with remimazolam in patients during rotator cuff repair and its influence on related indexes. Methods Eighty patients who underwent arthroscopic rotator cuff repair in the Second Hospital of Shanxi Medical University from July 2022 to July 2023 were enrolled and were divided into observation group and control group according to random number table method, with 40 cases in each group. Anesthesia induction of patients in the observation group was taken by sufentanil, rocuronium bromide, etomidate and a low-dose esketamine, while the maintenance was conducted by remimazolam and remifentanil; anesthesia induction of patients in the control group was taken by sufentanil, rocuronium bromide, etomidate, while the maintenance was conducted by propofol and remifentanil. Hemodynamic parameters, awakening time, recovery time of spontaneous respiration, Ricker sedation-restlessness score, VAS score at 6 and 12 h after surgery, stress response indexes, and anesthesia-related adverse reactions were observed in the two groups. Results After anesthesia, systolic blood pressure (112.75±12.59)mmHg, diastolic blood pressure (70.87±6.95) mmHg and heart rate (71.45±7.63) beats/min of patients in the observation group were higher than those of the control group which were (98.37±12.77)mmHg, (65.57±7.46)mmHg and (71.35±6.38)beats/min respectively, and the differences were statistically significant (P<0.05). The time of awakening (4.63±4.72)min and recovery of spontaneous respiration (5.39±0.92) min in the observation group was shorter than the time of awakening (5.29±0.44) min and recovery of spontaneous respiration (8.23±1.34) min in the control group. Ricker sedation-restlessness score and the VAS score of the postoperative period of 6h were lower than those of the control group (P<0.05). the postoperative values of cortisol, epinephrine, ACTH and malondialdehyde in observation group were lower than those in the control group, the postoperative superoxide dismutase were higher than those in the control group, and the incidence of postoperative adverse reactions was lower than that in the control group, with statistical significance (P< 0.05). Conclusions The use of low-dose esketamine combined with remimazolam for anesthesia maintenance in rotator cuff repair can maintain hemodynamic stability, improve the quality of awakening, reduce the stress response, and reduce the incidence of anesthesia-related adverse reactions.
关键词
瑞马唑仑 /
艾司氯胺酮 /
血流动力学参数 /
氧化应激 /
肩袖修补复术
Key words
remimazolam /
esketamine /
hemodynamic parameter /
oxidative stress /
rotator cuff repair
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