依托咪酯-氯胺酮联合麻醉对老年风湿性心脏瓣膜病行心脏瓣膜置换术患者围术期心电图及术后认知功能障碍的影响

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依托咪酯-氯胺酮联合麻醉对老年风湿性心脏瓣膜病行心脏瓣膜置换术患者围术期心电图及术后认知功能障碍的影响

贵州医科大学   麻醉与心脏电生理课题组

翻译:文春雷   编辑：马艳燕   审校：曹莹

背景：探讨依托咪酯-氯胺酮联合麻醉对老年风湿性心脏瓣膜病（RHVD）行心脏瓣膜置换术患者围手术期心电图（ECG）及术后认知功能障碍（POCD）的影响。

方法: 对我院2019年5月-2020年5月期间的100例老年RHVD患者进行回顾性分析，采用双盲法，患者根据使用的麻醉方法分为氯胺酮组（n=50）和依托咪酯-氯胺酮联合组（n=50）。在麻醉诱导过程中，两组患者泵注小剂量氯胺酮（0.5mg/kg）5μg/kg/min，直至手术结束，在此基础上，采用相同的麻醉措施，联合组再给予依托咪酯（0.3 mg/kg）。比较两组患者围手术期心电图指标、POCD评分、数字评分量表（NRS）评分。

结果：与氯胺酮组相比，联合组麻醉诱导后、插管及切皮时ST-T波变化发生率显著降低（P < 0.05），麻醉诱导后ST段低陷平均幅度显著降低（P < 0.001），麻醉诱导拔管后ST段平均升高显著降低（P < 0.001），POCD发生率显著降低（6.%，P < 0.05），术后NRS评分显著改善(P < 0.001）。

结论：依托咪酯-氯胺酮联合麻醉可稳定老年RHVD患者心脏瓣膜置换术围手术期心电图指标，改善术后认知功能，减轻疼痛感，应在临床中得到推广和应用。

原始文献来源：Ling Yang,Jingyang Xie,and Dan Hou. Effect of Combined Etomidate-Ketamine Anesthesia on Perioperative Electrocardiogram and Postoperative Cognitive Dysfunction of Elderly Patients with Rheumatic Heart Valve Disease Undergoing Heart Valve Replacement.[J]. J Healthc Eng (2022) 2022:2040-2309.

英文原文：

Effect of Combined Etomidate-Ketamine Anesthesia on Perioperative Electrocardiogram and Postoperative Cognitive Dysfunction of Elderly Patients with Rheumatic Heart Valve

Disease Undergoing Heart Valve Replacement 

BACKGROUND: To explore the effect of combined etomidate-ketamine anesthesia on perioperative electrocardiogram (ECG) and postoperative cognitive dysfunction (POCD) of elderly patients with rheumatic heart valve disease (RHVD) undergoing heart valve replacement.

METHODS: The data of 100 elderly RHVD patients treated in our hospital from May 2019 to May 2020 were selected for the retrospective analysis, and by adopting the double-blind method, the patients were divided into the ketamine group (n=50) and the combined group (n=50) according to the anesthesia methods. During the induction of anesthesia, the patients of the two groups were given a small dose of ketamine (0.5 mg/kg) at 5 μg/kg/min continuously via pump injection until the end of surgery, and on this basis, with the same anesthesia measures, those in the combined group were given etomidate (0.3 mg/kg) additionally. +e patients’ perioperative ECG indicators, POCD scores, and Numeric Rating Scale (NRS) scores were compared between the two groups.

RESULTS: Compared with the ketamine group, the combined group presented significantly lower incidence of ST-T wave changes after anesthesia induction and at the time of intubation and skin incision (P < 0.05), significantly lower average magnitude of ST-segment depression after anesthesia induction (P < 0.001), significantly lower average magnitude of ST-segment elevation after anesthesia induction and extubation (P < 0.001), significantly lower POCD incidence (6.%, P < 0.05), and significantly better NRS score after surgery (P < 0.001.

CONCLUSIONS: Combined etomidate-ketamine anesthesia can stabilize the perioperative ECG indicators of elderly RHVD patients undergoing heart valve replacement, improve their postoperative cognitive function, and reduce their pain sensation, which should be promoted and applied in practice.

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文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：MiLu.米鹭

校对：Michel.米萱

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