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Article(id=1241720035283104211, tenantId=1146029695717560320, journalId=1205117082300743687, issueId=1241720034091914228, articleNumber=null, orderNo=null, doi=10.14109/j.cnki.xyylc.2024.06.10, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1673193600000, receivedDateStr=2023-01-09, revisedDate=null, revisedDateStr=null, acceptedDate=1706544000000, acceptedDateStr=2024-01-30, onlineDate=1773978726454, onlineDateStr=2026-03-20, pubDate=1719244800000, pubDateStr=2024-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773978726454, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773978726454, creator=13701087609, updateTime=1773978726454, updator=13701087609, issue=Issue{id=1241720034091914228, tenantId=1146029695717560320, journalId=1205117082300743687, year='2024', volume='43', issue='6', pageStart='401', pageEnd='480', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773978726169, creator=13701087609, updateTime=1773979021315, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241721272128828343, tenantId=1146029695717560320, journalId=1205117082300743687, issueId=1241720034091914228, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241721272128828344, tenantId=1146029695717560320, journalId=1205117082300743687, issueId=1241720034091914228, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=446, endPage=449, ext={EN=ArticleExt(id=1241720035568316885, articleId=1241720035283104211, tenantId=1146029695717560320, journalId=1205117082300743687, language=EN, title=Effects of sub-anesthetic doses of esketamine on cerebral oxygenation in elderly patients undergoing hip arthroplasty, columnId=1207314218647392369, journalTitle=Chinese Journal of New Drugs and Clinical Remedies, columnName=Original Article, runingTitle=null, highlight=null, articleAbstract=
AIM

To investigate the effects of sub-anesthetic doses of esketamine on cerebral oxygenation and hemodynamics in elderly patients undergoing hip arthroplasty.

METHODS

Sixty patients ( age ≥ 65 years and ASA classification Ⅱ to Ⅲ) for elective hip arthroplasty were selected and randomly divided into 2 groups of 30 patients each.Anesthesia was induced and maintained essentially in the same way in the two groups, with the addition of esketamine 0.5 mg·kg-1 intravenously at the time of induction followed by continuous pumping with esketamine 0.25 mg·kg-1·h-1 in the experimental group, and an equal amount of sodium chloride injection given at the corresponding time point in the control group. The mean arterial pressure (MAP), heart rate (HR), surgical volume index (SPI), and regional cerebral oxygen saturation (rSO2) were collected at the patient’s admission to the operating room (T0), 3 min after the procedure of induction (T1), intubation were immediately applied (T2), 10 min after induction (T3), skin incision (T4) and 1 h after surgery (T5). The intraoperative drug use and recovery quality during awakening were observed.

RESULTS

Compared with that at T0, MAP (except T4 in the experimental group) and SPI was significantly lower (P<0.05) and rSO2 was significantly higher (P<0.05) at all time points from T1 to T5 in the two groups. Compared with the control group, MAP was significantly increased at T1, T2, T3 in the experimental group (P<0.05). There was no significant difference in SPI, HR, and rSO2 between the two groups from T1 to T5 (P>0.05). The intraoperative usage rates of atropine and ephedrine, and the dosages of propofol and remifentanil in the experimental group were significantly lower than those in the control group (P<0.05).There was no significant difference in postoperative eye opening time and extubation time between the two groups (P>0.05).

CONCLUSION

The sub-anesthetic doses of esketamine has no significant effect on the rSO2 in elderly patients undergoing hip arthroplasty, which can provide more stable hemodynamics for patients undergoing anesthesia, and help maintain the balance between supply and demand of oxygen in brain tissue during perioperative period.

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目的

探讨亚麻醉剂量艾司氯胺酮对髋关节置换术老年患者脑氧合及血流动力学的影响。

方法

选择择期行髋关节置换术患者60例，年龄≥65岁，ASA分级Ⅱ～Ⅲ级，随机分为2组，每组30例。2组麻醉诱导和维持方式基本相同，试验组在诱导时加用艾司氯胺酮0.5 mg·kg-1静脉注射，后以艾司氯胺酮0.25 mg·kg-1·h-1持续泵注，对照组在相应时点给予等量氯化钠注射液。记录入手术室时（T0）、诱导后3 min（T1）、插喉罩即刻（T2）、诱导后10 min（T3）、切皮时（T4）及手术1 h（T5）的平均动脉压（MAP）、心率（HR）、手术容积指数（SPI）和局部脑氧饱和度（rSO2），观察术中用药情况、苏醒期恢复质量。

结果

与T0比较，2组T1~T5各时点（除试验组T4）MAP、SPI均显著降低（P<0.05），rSO2均显著升高（P<0.05）。试验组T1、T2、T3的MAP显著高于对照组（P<0.05），T1~T5各时点SPI、HR、rSO2组间比较无显著差异（P>0.05）。试验组术中阿托品和麻黄碱使用率、丙泊酚和瑞芬太尼用量均显著低于对照组（P<0.05）。2组患者术后睁眼时间和拔管时间比较无显著差异（P>0.05）。

结论

亚麻醉剂量艾司氯胺酮对髋关节置换术老年患者的rSO2无明显影响，可使患者血流动力学更稳定，有利于维持围术期脑组织的氧供需平衡。

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林全阳，E-mail：
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王国立，女，住院医师，硕士，主要从事围术期重要脏器保护的研究，E-mail：

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J Cardiothorac Vasc Anesth, 2010, 24（1）: 131-142., articleTitle=Neuroprotection by ketamine: a review of the experimental and clinical evidence, refAbstract=null)], funds=[Fund(id=1241720040387572329, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241720035283104211, awardId=3502Z20227349, language=CN, fundingSource=厦门市自然科学基金联合项目(3502Z20227349), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241720038089093610, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241720035283104211, xref=1., ext=[AuthorCompanyExt(id=1241720038093287915, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241720035283104211, companyId=1241720038089093610, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.Department of Anesthesiology, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen FUJIAN 361006, China), AuthorCompanyExt(id=1241720038101676524, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241720035283104211, companyId=1241720038089093610, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.复旦大学附属中山医院厦门医院 麻醉科，福建 厦门　361006)]), AuthorCompany(id=1241720038185562607, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241720035283104211, xref=2., ext=[AuthorCompanyExt(id=1241720038193951216, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241720035283104211, companyId=1241720038185562607, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.Department of Anesthesiology, Zhongshan Hospital, Xiamen University, Xiamen FUJIAN 361000, China), AuthorCompanyExt(id=1241720038198145521, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241720035283104211, companyId=1241720038185562607, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.厦门大学附属中山医院 麻醉科，福建 厦门　361000)])], figs=[ArticleFig(id=1241720039989113425, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241720035283104211, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
指标对照组试验组
性别（男/女）/例16/1413/17a
ASA分级（Ⅱ/Ⅲ）/例19/1120/10a
年龄/岁69.8±4.169.6±3.7a
体重指数/kg·m-223.9±2.124.2±2.0a
手术时间/min147.0±15.9150.5±15.8a
出血量/mL276.7±127.8305.0±123.4a
术中用药
阿托品/例（%）8（27）2（7）b
麻黄碱/例（%）13（43）2（7）b
丙泊酚用量/mg396±19335±31b
瑞芬太尼用量/μg1 892±1571 524±162b
), ArticleFig(id=1241720040072999508, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241720035283104211, language=CN, label=表1, caption=

一般资料和术中情况组间比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标对照组试验组
性别（男/女）/例16/1413/17a
ASA分级（Ⅱ/Ⅲ）/例19/1120/10a
年龄/岁69.8±4.169.6±3.7a
体重指数/kg·m-223.9±2.124.2±2.0a
手术时间/min147.0±15.9150.5±15.8a
出血量/mL276.7±127.8305.0±123.4a
术中用药
阿托品/例（%）8（27）2（7）b
麻黄碱/例（%）13（43）2（7）b
丙泊酚用量/mg396±19335±31b
瑞芬太尼用量/μg1 892±1571 524±162b
), ArticleFig(id=1241720040156885592, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241720035283104211, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别时间MAP/mmHgHR/次·min-1SPIrSO2
对照T0104.5±8.068.7±8.147.7±12.163.7±3.2
T173.9±9.4b66.5±10.3a30.5±11.3b66.9±2.9b
T274.6±6.7b64.5±9.6a31.6±8.2b66.6±2.8b
T377.3±8.0b62.6±11.4a30.8±9.3b67.3±2.3b
T496.9±7.4b61.7±8.9a39.0±12.6b67.2±2.2b
T5100.3±5.1b63.6±9.2a39.4±11.6b67.3±2.4b
试验T0105.9±7.8d68.1±9.9d47.3±16.3d63.3±3.1d
T195.8±9.1be70.8±10.0ad32.7±8.8bd67.9±3.0bd
T294.8±9.6be67.9±9.2ad32.7±11.1bd67.4±3.6bd
T391.0±8.6be65.3±10.4ad32.4±12.1bd68.1±3.2bd
T4100.6±11.9ad64.4±10.7ad41.6±10.4bd67.9±2.9bd
T598.9±9.2bd63.5±9.4ad39.4±11.4bd67.4±3.4bd
), ArticleFig(id=1241720040240771679, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241720035283104211, language=CN, label=表2, caption=

血流动力学指标和局部脑氧饱和度（rSO2）组间比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别时间MAP/mmHgHR/次·min-1SPIrSO2
对照T0104.5±8.068.7±8.147.7±12.163.7±3.2
T173.9±9.4b66.5±10.3a30.5±11.3b66.9±2.9b
T274.6±6.7b64.5±9.6a31.6±8.2b66.6±2.8b
T377.3±8.0b62.6±11.4a30.8±9.3b67.3±2.3b
T496.9±7.4b61.7±8.9a39.0±12.6b67.2±2.2b
T5100.3±5.1b63.6±9.2a39.4±11.6b67.3±2.4b
试验T0105.9±7.8d68.1±9.9d47.3±16.3d63.3±3.1d
T195.8±9.1be70.8±10.0ad32.7±8.8bd67.9±3.0bd
T294.8±9.6be67.9±9.2ad32.7±11.1bd67.4±3.6bd
T391.0±8.6be65.3±10.4ad32.4±12.1bd68.1±3.2bd
T4100.6±11.9ad64.4±10.7ad41.6±10.4bd67.9±2.9bd
T598.9±9.2bd63.5±9.4ad39.4±11.4bd67.4±3.4bd
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亚麻醉剂量艾司氯胺酮对髋关节置换术老年患者脑氧合的影响
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王国立 1 , 林全阳 2 , 郑青麒 2 , 马保新 2
中国新药与临床杂志 | 论著 2024,43(6): 446-449
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中国新药与临床杂志 | 论著 2024, 43(6): 446-449
亚麻醉剂量艾司氯胺酮对髋关节置换术老年患者脑氧合的影响
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王国立1 , 林全阳2 , 郑青麒2, 马保新2
作者信息
  • 1.复旦大学附属中山医院厦门医院 麻醉科，福建 厦门　361006
  • 2.厦门大学附属中山医院 麻醉科，福建 厦门　361000

    • 王国立，女，住院医师，硕士，主要从事围术期重要脏器保护的研究，E-mail：

通讯作者:

林全阳，E-mail：
Effects of sub-anesthetic doses of esketamine on cerebral oxygenation in elderly patients undergoing hip arthroplasty
Guo-li WANG1 , Quan-yang LIN2 , Qing-qi ZHENG2, Bao-xin MA2
Affiliations
  • 1.Department of Anesthesiology, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen FUJIAN 361006, China
  • 2.Department of Anesthesiology, Zhongshan Hospital, Xiamen University, Xiamen FUJIAN 361000, China
出版时间: 2024-06-25 doi: 10.14109/j.cnki.xyylc.2024.06.10
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摘要
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目的

探讨亚麻醉剂量艾司氯胺酮对髋关节置换术老年患者脑氧合及血流动力学的影响。

方法

选择择期行髋关节置换术患者60例，年龄≥65岁，ASA分级Ⅱ～Ⅲ级，随机分为2组，每组30例。2组麻醉诱导和维持方式基本相同，试验组在诱导时加用艾司氯胺酮0.5 mg·kg-1静脉注射，后以艾司氯胺酮0.25 mg·kg-1·h-1持续泵注，对照组在相应时点给予等量氯化钠注射液。记录入手术室时（T0）、诱导后3 min（T1）、插喉罩即刻（T2）、诱导后10 min（T3）、切皮时（T4）及手术1 h（T5）的平均动脉压（MAP）、心率（HR）、手术容积指数（SPI）和局部脑氧饱和度（rSO2），观察术中用药情况、苏醒期恢复质量。

结果

与T0比较，2组T1~T5各时点（除试验组T4）MAP、SPI均显著降低（P<0.05），rSO2均显著升高（P<0.05）。试验组T1、T2、T3的MAP显著高于对照组（P<0.05），T1~T5各时点SPI、HR、rSO2组间比较无显著差异（P>0.05）。试验组术中阿托品和麻黄碱使用率、丙泊酚和瑞芬太尼用量均显著低于对照组（P<0.05）。2组患者术后睁眼时间和拔管时间比较无显著差异（P>0.05）。

结论

亚麻醉剂量艾司氯胺酮对髋关节置换术老年患者的rSO2无明显影响，可使患者血流动力学更稳定，有利于维持围术期脑组织的氧供需平衡。

艾司氯胺酮  /  老年人  /  关节成形术，置换，髋  /  局部脑氧饱和度
AIM

To investigate the effects of sub-anesthetic doses of esketamine on cerebral oxygenation and hemodynamics in elderly patients undergoing hip arthroplasty.

METHODS

Sixty patients ( age ≥ 65 years and ASA classification Ⅱ to Ⅲ) for elective hip arthroplasty were selected and randomly divided into 2 groups of 30 patients each.Anesthesia was induced and maintained essentially in the same way in the two groups, with the addition of esketamine 0.5 mg·kg-1 intravenously at the time of induction followed by continuous pumping with esketamine 0.25 mg·kg-1·h-1 in the experimental group, and an equal amount of sodium chloride injection given at the corresponding time point in the control group. The mean arterial pressure (MAP), heart rate (HR), surgical volume index (SPI), and regional cerebral oxygen saturation (rSO2) were collected at the patient’s admission to the operating room (T0), 3 min after the procedure of induction (T1), intubation were immediately applied (T2), 10 min after induction (T3), skin incision (T4) and 1 h after surgery (T5). The intraoperative drug use and recovery quality during awakening were observed.

RESULTS

Compared with that at T0, MAP (except T4 in the experimental group) and SPI was significantly lower (P<0.05) and rSO2 was significantly higher (P<0.05) at all time points from T1 to T5 in the two groups. Compared with the control group, MAP was significantly increased at T1, T2, T3 in the experimental group (P<0.05). There was no significant difference in SPI, HR, and rSO2 between the two groups from T1 to T5 (P>0.05). The intraoperative usage rates of atropine and ephedrine, and the dosages of propofol and remifentanil in the experimental group were significantly lower than those in the control group (P<0.05).There was no significant difference in postoperative eye opening time and extubation time between the two groups (P>0.05).

CONCLUSION

The sub-anesthetic doses of esketamine has no significant effect on the rSO2 in elderly patients undergoing hip arthroplasty, which can provide more stable hemodynamics for patients undergoing anesthesia, and help maintain the balance between supply and demand of oxygen in brain tissue during perioperative period.

esketamine  /  aged  /  arthroplasty, replacement, hip  /  regional cerebral oxygen saturation
王国立, 林全阳, 郑青麒, 马保新. 亚麻醉剂量艾司氯胺酮对髋关节置换术老年患者脑氧合的影响. 中国新药与临床杂志, 2024 , 43 (6) : 446 -449 . DOI: 10.14109/j.cnki.xyylc.2024.06.10
Guo-li WANG, Quan-yang LIN, Qing-qi ZHENG, Bao-xin MA. Effects of sub-anesthetic doses of esketamine on cerebral oxygenation in elderly patients undergoing hip arthroplasty[J]. Chinese Journal of New Drugs and Clinical Remedies, 2024 , 43 (6) : 446 -449 . DOI: 10.14109/j.cnki.xyylc.2024.06.10
正文
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老年人器官功能储备下降、自动调节能力下降，围术期容易出现低血压，同时脑血流量易受血压波动影响，更容易出现脑组织的氧供需失衡。常用的静脉麻醉药丙泊酚会抑制循环，在麻醉后常引起血压降低、心动过缓等，对于老年患者更为严重[1]。氯胺酮可激活交感神经系统，使心率（HR）和血压升高，从而使脑血流量升高[2]，与丙泊酚联合使用可减少血流动力学不良反应[3,4]。艾司氯胺酮是氯胺酮的右旋异构体，镇痛作用更强、苏醒时间更短，且有对呼吸、循环抑制弱的特点，已在临床上广泛应用[5,6]。但目前亚麻醉剂量艾司氯胺酮联合全身麻醉（全麻）对老年患者围术期脑氧合的影响尚未明确，因此本研究主要观察亚麻醉剂量艾司氯胺酮对老年髋关节置换术患者脑氧合和血流动力学的影响。
资料与方法
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病例选择和分组
选择2020年3月至2021年8月于厦门大学附属中山医院行单侧髋关节置换的老年患者，年龄≥65岁，ASA分级Ⅱ~Ⅲ级。排除标准：（1）存在中枢神经系统疾病或精神疾病；（2）严重心、肺、肝、肾功能不全；（3）文盲及简易精神状态检查（MMSE）评分< 24分；（4）有听力、视力障碍或无法交流；（5）青光眼；（6）甲状腺功能亢进；（7）控制不佳的高血压（血压>180/100 mmHg）。共纳入60例患者，采用随机数字表法分为试验组和对照组，每组30例。本研究经厦门大学附属中山医院伦理委员会审核通过，批件号为xmzsyyky伦审第（2022-191），所有患者都知情同意。
麻醉方法
常规禁食8 h，禁饮4 h，不使用术前药物。入室后监测患者无创血压、心电图（ECG）、HR、脉搏氧饱和度（SpO2）、手术容积指数（SPI）、脑电双频指数（BIS），开放外周静脉通路。用酒精擦拭前额和探头，待风干后将脑氧饱和度监测仪（Invos 5100，Somanetics Corporation）探头固定于左前额，眉骨上方1.5 cm，避开脑中线并进行避光处理。麻醉前在手术侧行超声引导下髂筋膜阻滞，予0.25%罗哌卡因25 mL。面罩吸入纯氧后静脉注射（静注）舒芬太尼0.2~0.4 mg·kg-1、丙泊酚1~2 mg·kg-1和罗库溴铵0.5 μg·kg-1麻醉诱导，待下颌松弛后置入喉罩，调整喉罩不漏气，连接麻醉机机械通气，调整呼吸机参数为50%空气氧气混合，潮气量6~10 mL·kg-1，呼吸频率10~14次·min-1，维持呼吸末二氧化碳分压在35~40 mmHg；泵注瑞芬太尼0.1~0.2 μg·kg-1·min-1、丙泊酚4~10 mg·kg-1·h-1麻醉维持，根据术中SPI和BIS调整泵速，间断静注罗库溴铵0.2~0.3 mg·kg-1。试验组在诱导时加用艾司氯胺酮（江苏恒瑞医药股份有限公司，批号：211101BL）0.5 mg·kg-1静注，后持续泵注艾司氯胺酮0.25 mg·kg-1·h-1，对照组在相应时点给予等量氯化钠注射液。当术中血压比术前高30%时，予以乌拉地尔10 mg静注，当血压比术前低30%时，予以麻黄碱6 mg静注；当HR<45次·min-1，予以阿托品0.5 mg·kg-1静注。手术结束前30 min，予以地佐辛5 mg静注、托烷司琼5 mg静注。试验组手术结束前20 min停用艾司氯胺酮，2组均于缝皮完毕停用丙泊酚、瑞芬太尼，手术结束后转至复苏室。
观察指标
　术前1 d对患者进行评估，记录患者身高、体重、年龄、性别及ASA分级。记录入手术室时（T0）、诱导后3 min（T1）、插喉罩即刻（T2）、诱导后10 min（T3）、切皮时（T4）及手术1 h（T5）的平均动脉压（MAP）、SPI、HR和局部脑氧饱和度（rSO2），以及术中丙泊酚、瑞芬太尼用量和血管活性药物使用情况。记录2组患者睁眼时间（从麻醉结束至睁眼时间）、拔管时间（从麻醉结束至拔除气管导管时间）及术后不良反应的发生率。
统计学方法
采用SPSS 24.0统计学软件进行分析。正态分布的计量资料以均数±标准差表示，组间比较采用t检验，组内比较采用重复测量设计的方差分析；计数资料比较采用卡方检验。P<0.05为差异有显著意义。
结果
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一般情况
2组性别、年龄、体重指数、手术时间、出血量比较，差异均无显著意义（P>0.05）。2组均未使用乌拉地尔，与对照组比较，试验组术中阿托品、麻黄碱使用率降低（P<0.05），丙泊酚和瑞芬太尼用量减少（P<0.05）。见表1。
血流动力学和脑氧饱和度
　与T0比较，2组T1~T5的MAP（除试验组T4）、SPI均显著降低（P<0.05），rSO2均显著升高（P<0.05），HR无明显变化。与对照组比较，试验组T1、T2、T3的MAP增高，差异有显著意义（P<0.05），2组各观察时点HR、SPI、rSO2无显著差异（P>0.05）。见表2。
苏醒期恢复质量
对照组睁眼时间和拔管时间分别为（8.5±3.3）和（10.9±2.6）min，试验组分别为（9.4±3.6）和（11.6±4.0）min，2组患者睁眼时间和拔管时间比较均无显著差异（P>0.05）。试验组和对照组发生术后躁动各1例，对照组发生恶心呕吐15例（50%），试验组16例（53%）；对照组发生头晕3例（10%），试验组4例（13%）；对照组发生失重感1例（3%），试验组无。各不良反应发生率组间比较均无显著差异（P>0.05）。
讨论
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既往研究发现，亚麻醉剂量氯胺酮（0.5 mg·kg-1·h-1）可以提供持续的镇静和镇痛效果，而艾司氯胺酮对N-甲基-D天冬氨酸（NMDA）受体的亲和力更高，达到同样效果时仅需氯胺酮一半的剂量[7,8]，所以本研究选择艾司氯胺酮亚麻醉剂量为0.25 mg·kg-1·h-1。为减少气管插管反应对老年患者循环系统的影响，本研究采用喉罩全麻，虽然髋关节置换术采用侧卧位，喉罩有可能随着体位的变动发生位移，影响通气质量，但多项研究证实，喉罩可安全用于侧卧位的手术麻醉中[9,10]。本研究中对照组T1、T2、T3的血压下降明显，血管活性药的使用率明显升高，而同时点试验组血压高于对照组，提示联合使用艾司氯胺酮患者血压较平稳，考虑与艾司氯胺酮具有拟交感作用有关，可提高心肌收缩力并增加血管阻力，进而升高动脉压并使心率增快来保持心输出量。然而，在本研究中，与对照组相比，试验组患者HR未明显增快，这可能与艾司氯胺酮联合丙泊酚有关。
临床研究已证实脑氧饱和度可反映脑血流变化和脑缺血情况[11,12]。本研究中，2组T1的rSO2均较基线迅速升高，可能与诱导过程纯氧通气使血液中氧浓度提高，进而使脑组织的氧供增加有关；也可能与机体在进入手术麻醉期后，耗氧量降低，脑组织的氧耗减少有关。有研究发现，给予自主呼吸患者氯胺酮后，动脉二氧化碳分压（PaCO2）增高，引起脑血流和脑代谢增加，从而导致颅内压升高，而在机械通气和镇静条件下，保持PaCO2稳定不会影响脑血流和脑代谢[13,14]。本研究的各观察时点，2组rSO2未见显著差异，考虑与采用机械通气，术中维持呼气末二氧化碳分压在35~40 mmHg有关。艾司氯胺酮与丙泊酚的联合使用也可能是2组rSO2未见明显差异的原因，丙泊酚呈剂量相关性降低脑血流和脑氧耗，且对二氧化碳的反应性无影响。另外，2组睁眼时间、拔管时间、苏醒躁动以及术后恶心呕吐、头晕等发生情况差异无显著意义，提示亚麻醉剂量艾司氯胺酮可安全用于髋关节置换术的老年患者。
综上所述，亚麻醉剂量艾司氯胺酮对髋关节置换术老年患者的rSO2无明显影响，可使患者的血流动力学更稳定，有利于围术期脑组织氧供需平衡的维持。但本研究未监测脑血流量变化，艾司氯胺酮是否可以增加氧气储备，从而降低大脑缺氧的发生还需进一步观察。
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2024年第43卷第6期
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doi: 10.14109/j.cnki.xyylc.2024.06.10
  • 接收时间：2023-01-09
  • 首发时间：2026-03-20
  • 出版时间：2024-06-25
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  • 收稿日期：2023-01-09
  • 录用日期：2024-01-30
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厦门市自然科学基金联合项目(3502Z20227349)
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    1.复旦大学附属中山医院厦门医院 麻醉科，福建 厦门　361006
    2.厦门大学附属中山医院 麻醉科，福建 厦门　361000

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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