口腔医学研究

口腔医学研究 ›› 2023, Vol. 39 ›› Issue (1): 46-51.DOI: 10.13701/j.cnki.kqyxyj.2023.01.009

• 口腔颌面外科学研究 • 上一篇    下一篇

小剂量艾司氯胺酮在全身麻醉下口腔颌面外科短时间手术中的应用

辛志军, 王宁, 曲伟栋, 王花静, 王翠霞, 王天凤, 李建萍, 王怀洲*   

  1. 烟台市口腔医院手术麻醉科 山东 烟台 264000
  • 收稿日期:2022-08-04 发布日期:2023-01-28
  • 通讯作者: *王怀洲,E-mail:15288799081@163.com
  • 作者简介:辛志军(1986~ ),男,山东临沂人,硕士,主治医师,研究方向:临床麻醉,舒适化口腔诊疗。
  • 基金资助:
    烟台市科技局政策引导类项目(编号:2022YD100)

Application of Low Dose Esketamine in Short Time Operation of Oral and Maxillofacial Surgery under General Anesthesia

XIN Zhijun, WANG Ning, QU Weidong, WANG Huajing, WANG Cuixia, WANG Tianfeng, LI Jianping, WANG Huaizhou*   

  1. Department of Surgical Anesthesia, Yantai Stomatological Hospital, Yantai 264000, China
  • Received:2022-08-04 Published:2023-01-28

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摘要： 目的:探讨小剂量艾司氯胺酮在全身麻醉下口腔颌面外科短时间手术中的应用效果,为临床应用提供参考。方法:选取烟台市口腔医院口腔颌面外科76例住院手术的患者,男女各38例,应用随机数字表法将76例患者分为两组,A组为研究组即艾司氯胺酮组(n=46),B组为对照组(n=30),A组患者麻醉诱导方案:咪达唑仑1 mg,艾司氯胺酮0.25 mg/kg,芬太尼2 μg/kg,丙泊酚2 mg/kg,顺阿曲库铵0.2 mg/kg,昂丹司琼4 mg。B组患者为常规麻醉诱导方案,除芬太尼用量为4 μg/kg及不用艾司氯胺酮外,其他用药与A组相同,两组术中麻醉维持用药相同,手术开始时所有患者均由同一手术医生应用阿替卡因肾上腺素注射液实施局部浸润麻醉,手术结束前30 min停用七氟醚,手术结束时停用丙泊酚,待患者意识和自主呼吸恢复后拔除气管导管转入麻醉后复苏室观察。统计两组患者入室时(T1)、插管前(T2)、插管后(T3)、手术开始5 min时(T4)、手术结束时(T5)、拔管后即刻(T6)的心率(HR)、平均动脉压(MAP)、血氧饱和度(SPO2),记录手术时间(t1)和苏醒时间(t2),统计麻醉诱导时应用芬太尼所引起的呛咳反应发生率、丙泊酚注射痛发生率及术中丙泊酚用量,并记录术中、术后不良反应的发生情况。结果:A组患者应用芬太尼后出现呛咳反应的发生率、丙泊酚注射痛的发生率、术中丙泊酚的消耗量、术后苏醒时间明显低于B组,具有统计学差异(P＜0.05),两组患者各时间点的HR变化比较差异有统计学意义(P＜0.05),与T1相较,T2、T3、T4、T5时间点的HR较低,组间比较A组T2时间点的HR较B组高(P＜0.05)。两组患者各时间点的MAP变化差异具有统计学差异,与T1相较,T2、T4、T5、T6时间点的MAP较低;与T2相较,T3时间点的MAP较高;与T3相较,T4、T5时间点的MAP较低;与T5相较,T6时间点的MAP较高,差异具有统计学意义(P＜0.05),在T6时间点的SPO2略低于A组(P＜0.05),与T6相较,其他5个时间点的SPO2均高于T6,差异具有统计学意义(P＜0.05),A组患者低血压、心动过缓发生率较B组低,差异具有统计学意义(P＜0.05),两组患者术后嗜睡、呼吸抑制、术后疼痛的发生率无统计学差异(P＞0.05),但A组患者术后嗜睡的发生率较B组高,B组患者呼吸抑制、术后疼痛的发生率较A组高。结论:在口腔颌面外科的短时间手术中应用小剂量艾司氯胺酮进行全身麻醉诱导,可以明显降低芬太尼呛咳反应和丙泊酚注射痛的发生率,减少芬太尼的用量和术中丙泊酚的用量,术中血流动力学更趋平稳,不延长术后苏醒时间,且可降低术中术后不良反应的发生率,安全性较高,具有较高的临床应用价值。

关键词: 艾司氯胺酮, 全身麻醉, 口腔外科, 颌面外科, 短小手术, 应用

Abstract: Objective: To investigate the application effect of low-dose esketamine in oral and maxillofacial surgery under general anesthesia for short time operation. Methods: Seventy-six inpatients (38 males and 38 females) with oral and maxillofacial surgery in Yantai Hospital of Stomatology were randomly divided into two groups by random number table method. Group A was the study group (Esketamine group, n=46), and group B was the control group (n=30). The patients in Group A were administrated with Midazolam 1 mg, Esketamine 0.25 mg/kg, Fentanyl 2 μg/kg, Propofol 2 mg/kg, Cisatracurium 0.2 mg/kg, and Ondansetron 4 mg. Patients in group B were given the conventional anesthesia induction regimen, and the medications were the same as those in group A except that the dosage of Fentanyl was 4 μg/kg and Esketamine was not used. After induction of anesthesia, patients in the two groups were intubated through the nasal cavity and trachea, and mechanical ventilation was performed by the anesthesia machine. Anesthesia maintenance drugs in the two groups were the same. At the beginning of the operation, all patients were given local infiltration anesthesia by the same surgeon with Attevacaine and epinephrine injection. After the patient were recovered consciousness and spontaneous breathing, the tracheal tube was removed and the patients were transferred to PACU for observation. The HR, MAP, and SPO2 of the two groups at the time of entry (T1), before intubation (T2), after intubation (T3), at the beginning of operation (T4), at the end of operation (T5), and after extubation (T61) were recorded. The operation time (T1) and recovery time (T2) were recorded. The incidence of choking reaction caused by Fentanyl during anesthesia induction, the incidence of Propofol injection pain, and the amount of Propofol used during operation were recorded, and the intraoperative and postoperative adverse reactions were recorded. Results: The incidence of choking reaction after Fentanyl application, the incidence of Propofol injection pain, the consumption of Propofol during operation, and the recovery time after operation in group A were significantly lower than those in group B (P<0.05). The HR changes of the two groups at each time point were statistically significant (P<0.05), compared with T1. The HR at T2, T3, T4, and T5 time points was lower, and the HR at T2 time point in group A was higher than that in group B (P<0.05). Compared with T1, T2, T4, T5, and T6 had lower MAP; compared with T2, T3 had higher MAP; compared with T3, T4 and T5 had lower MAP; compared with T5, T6 had higher MAP. The difference was statistically significant (P<0.05). SPO2 at T6 was slightly lower than that in group A (P<0.05). Compared with T6, SPO2 at the other five time points was higher than that in T6, and the difference was statistically significant (P<0.05). There was no significant difference in the incidence of postoperative somnolence, respiratory depression and postoperative pain between two groups (P>0.05), but the incidence of postoperative somnolence in group A was higher than that in group B, and the incidence of respiratory depression and postoperative pain in group B was higher than those in group A. Conclusion: In a short time operation of oral and maxillofacial surgery, escitalopram small doses of Esketamine anesthesia induction can significantly reduce Fentanyl choking cough response and the incidence of Propofol injection pain, reduce the dosage of Fentanyl and intraoperative Propofol dosage, smooth the intraoperative hemodynamics, maintain the time of postoperative revival, and reduce the incidence rate of intraoperative postoperative adverse reactions.

Key words: Esketamine, general anesthesia, oral surgery, maxillofacial surgery, short surgery, application