支撑喉镜刺激很大，哪个药能有效抑制？

本文由“小麻哥的日常”授权转载

摘要译文（供参考）

放置支撑喉镜前应用艾司氯胺酮与舒芬太尼的效果比较

目的：

喉显微手术中，支撑喉镜置入是一种强烈的刺激，可能引起血流动力学波动和心血管不良事件，本研究旨在比较艾司氯胺酮和舒芬太尼在支撑喉镜置入术中的预防性治疗对维持血流动力学稳定和减少心血管不良事件发生的影响。

方法：

采用随机、双盲、对照研究方法，将行喉显微手术全麻的患者随机分为艾司氯胺酮0.5mg ·kg-1组(艾司氯胺酮组)和舒芬太尼0.125μg ·kg-1组(舒芬太尼组)，每组1:1。

结果：

喉镜置入过程中，艾司氯胺酮组心动过缓(HR<60次/min)发生率为39.3%(22/56)，低于舒芬太尼组的60.0%(33/55)(OR=2.32，95%CI:1.11~5.08，p=0.029)。 艾司氯胺酮组低血压(MAP<65mmHg)发生率为33.9%(19/56)，低于舒芬太尼组的56.4%(31/55)(OR，2.52[95%CI，1.91-5.27]；p=0.018)。 艾司氯胺酮组低血压发生率低于舒芬太尼组(0.36±0.52 vs 0.56±0.50，p=0.035)。 艾司氯胺酮组HR下降超过基线30%的时间加权平均值小于舒芬太尼组(0.52±2.06 vs 1.08±2.77，p=0.006)。

结论： 

与舒芬太尼(0.125μg·kg~(-1))超前治疗相比，艾司氯胺酮(0.5mg·kg~(-1))能有效降低喉显微手术中悬吊喉镜置入引起的心动过缓和低血压等心血管不良事件的发生率。

证据等级：2，喉镜，2023年。

关键词：

麻醉；心动过缓；艾司氯胺酮；血流动力学；支撑喉镜。

原文摘要

Esketamine versus Sufentanil Applied Prior to Placement of Suspension Laryngoscope 

Objective: In laryngeal microsurgery, the insertion of the suspension laryngoscope is a strong stimulus that may cause hemodynamic fluctuations and adverse cardiovascular events. The purpose of this study was to compare the effect of preemptive treatment with esketamine and sufentanil on maintaining hemodynamics and reducing the occurrence of adverse cardiovascular events during the insertion of suspension laryngoscope.

Methods: In this double-blind randomized controlled trial, patients undergoing general anesthesia for laryngeal microsurgery were randomly assigned (1:1) to esketamine 0.5 mg kg-1 (esketamine group) and sufentanyl 0.125 μg kg-1 (sufentanil group) before inserting the laryngoscope, respectively. 

Results: During the insertion of suspension laryngoscope, the incidence of bradycardia (HR < 60 beats/min) was 39.3% (22/56) in esketamine group, lower than 60.0% (33/55) in sufentanil group (odds ratio [OR], 2.32 [95% CI, 1.11-5.08]; p = 0.029). The incidence of hypotension (MAP <65 mmHg) was 33.9% (19/56) in esketamine group, lower than 56.4% (31/55) in sufentanil group (odds ratio [OR], 2.52 [95% CI, 1.91-5.27]; p = 0.018). The frequency of hypotension in esketamine group was lower than that in sufentanil group (0.36 ± 0.52 vs. 0.56 ± 0.50, p = 0.035). The time-weighted average of HR dropping above 30% of baseline was smaller in esketamine group than in sufentanil group (0.52 ± 2.06 vs. 1.08 ± 2.77, p = 0.006).

Conclusions: These findings showed that compared with preemptive treatment of sufentanil (0.125 μg kg-1 ), esketamine (0.5 mg kg-1 ) was effective in reducing the incidence of cardiovascular adverse events, including bradycardia and hypotension induced by the insertion of suspension laryngoscope during the laryngeal microsurgery. Level of evidence: 2 Laryngoscope, 2023.

Keywords: anesthesia; bradycardia; esketamine; hemodynamic; suspension laryngoscope.

免责声明：

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：MiSuper.米超

校对：Michel.米萱  

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