艾司氯胺酮在一又二分之一鼻孔-蝶窦入路垂体瘤神经内镜切除术中的应用效果

doi:10.20047/j.issn1673-7210.2023.28.27

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摘要目的探讨艾司氯胺酮在一又二分之一鼻孔-蝶窦入路垂体瘤神经内镜切除术中的应用效果。方法选择2020年3月至2022年1月中国人民解放军联勤保障部队第九〇四医院98例接受一又二分之一鼻孔-蝶窦入路垂体瘤神经内镜切除术患者，按照随机数字表法将其分为研究组（49例）、对照组（49例）。研究组麻醉诱导前静脉注射艾司氯胺酮0.5 mg/kg，术中持续泵入0.1 mg/（kg·h）艾司氯胺酮至术毕；对照组以相同的方式静脉注射生理盐水。比较两组麻醉诱导前（T0）、气管插管后即刻（T1）、手术结束时（T2）、术后1 h（T3）、术后3 h（T4）的心率（HR）水平；比较两组T3、T4及术后6 h（T5）时视觉模拟评分法（VAS）评分；比较两组瑞芬太尼、丙泊酚用药量；比较两组苏醒期呛咳程度；观察两组苏醒期并发症发生情况。结果两组组内不同时间点HR两两比较，差异有统计学意义（P＜0.05）；T1~T4时，两组HR比较，差异有统计学意义（P＜0.05）。两组组内不同时间点VAS评分两两比较，差异有统计学意义（P＜0.05）；T3~T5时，研究组VAS评分低于对照组，差异有统计学意义（P＜0.05）。研究组瑞芬太尼、丙泊酚用药量低于对照组，差异有统计学意义（P＜0.05）。研究组呛咳程度低于对照组，差异有统计学意义（P＜0.05）。两组苏醒期并发症总发生率比较，差异无统计学意义（P＞0.05）。结论艾司氯胺酮应用于一又二分之一鼻孔-蝶窦入路垂体瘤神经内镜切除术中麻醉效果确切，维持血流动力学稳定，且安全可靠。

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	刘婷　　贾暄东　　汤燕彬　　肖骥峰　　廖兴志▲

关键词 ：艾司氯胺酮, 一又二分之一鼻孔-蝶窦入路, 垂体瘤神经内镜切除术, 麻醉效果

Abstract：Objective To investigate the application effect of Esketamine on neuroendoscopic resection of pituitary tumor by one-and-a-half nostril-sphenoid sinus approach. Methods A total of 98 patients who underwent neuroendoscopic resection of pituitary tumor by one-and-a-half nostril-sphenoid sinus approach from 904th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army from March 2020 to January 2022 were selected, and they were divided into study group (49 cases) and control group (49 cases) by random number table method. In study group, Esketamine 0.5 mg/kg was injected intravenously before anesthesia induction, and 0.1 mg/(kg·h) Esketamine was pumped continuously during the operation until the end of the operation; and control group was given intravenous saline in the same way. The heart rate (HR) levels of two groups were compared before anesthesia induction (T0), immediately after tracheal intubation (T1), at the end of surgery (T2), 1 h after surgery (T3) and 3 h after surgery (T4); visual analog scale (VAS) scores of T3, T4, and 6 h after surgery (T5) were compared between two groups; the dosage of Remifentanil and Propofol were compared between the two groups; the coughing degree of two groups was compared; and the occurrence of complications during recovery period was observed in the two groups. Results There was significant difference in HR between two groups at different time points within the group (P＜0.05); at T1-T4, there were statistical significances in HR between two groups (P＜0.05). The VAS scores of two groups at different time points were compared, and the difference was statistically significant (P＜0.05); at T3-T5, the VAS scores of study group were lower than those of control group, and the differences were statistically significant (P＜0.05). The dosage of Remifentanil and Propofol in study group were lower than those in control group, and the differences were statistically significant (P＜0.05). The coughing degree of study group was lower than that of control group, and the difference was statistically significant (P＜0.05). There was no significant difference in the total incidence of complications during recovery between two groups (P＞0.05). Conclusion Esketamine is effective on neuroendoscopic resection of pituitary tumor by one-and-a-half nostril-sphenoid sinus approach, maintaining hemodynamic stability, safety and reliability.

Key words： Esketamine One-and-a-half nostril-sphenoid sinus approach Neuroendoscopic resection of pituitary tumor Anesthetic effect

基金资助:江苏省自然科学基金项目（BK20211382）；
江苏省无锡市卫生健康委员会面上项目（M202233）。

通讯作者: ▲通讯作者

作者简介: 刘婷（1985.3-），女，硕士；研究方向：临床麻醉与脏器保护。

引用本文:

刘婷　　贾暄东　　汤燕彬　　肖骥峰　　廖兴志▲. 艾司氯胺酮在一又二分之一鼻孔-蝶窦入路垂体瘤神经内镜切除术中的应用效果[J]. 中国医药导报, 2023, 20(28): 123-126.
LIU Ting JIA Xuandong TANG Yanbin XIAO Jifeng LIAO Xingzhi▲. Application effect of Esketamine on neuroendoscopic resection of pituitary tumor by one-and-a-half nostril-sphenoid sinus approach. 中国医药导报, 2023, 20(28): 123-126.

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https://www.yiyaodaobao.com.cn/CN/10.20047/j.issn1673-7210.2023.28.27 或 https://www.yiyaodaobao.com.cn/CN/Y2023/V20/I28/123