依托咪酯和氯胺酮复合全身麻醉对脑血流速度的影响：一项随机临床试验。
The effect of esketamine combined with propofol-induced general anesthesia on cerebral blood flow velocity: a randomized clinical trial.
机构信息
Department of Anesthesiology, The First Affiliate Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District Chongqing, China.
出版信息
BMC Anesthesiol. 2024 Feb 20;24(1):66. doi: 10.1186/s12871-024-02446-4.
BACKGROUND
Esketamine is increasingly used in clinical anesthesia. The effect of esketamine on the blood flow velocity of the middle cerebral artery has a clinical guiding effect. To investigate the effect of esketamine combined with propofol-induced general anesthesia for endotracheal intubation on the blood flow velocity of middle cerebral artery and hemodynamics during the induction period.
METHODS
The randomized clinical trial included 80 patients aged 20-65 years who would undergo non-intracranial elective surgery under general anesthesia in our hospital from May 2022 to May 2023. The participants were divided into two groups based on anesthesia drugs: sufentanil 0.5μg/kg (group C) or 1.5mg/kg esketamine (group E). The primary outcome was variation value in average cerebral blood velocity. The secondary outcomes included cerebral blood flow velocities (CBFV), blood pressure (BP) and heart rate (HR) at four different time points: before induction of general anesthesia (T), 1 min after the induction drug injected (T), before endotracheal intubation (T), and 1min after endotracheal intubation (T). The occurrence of hypotension, hypertension, tearing and choking during induction was also documented.
RESULTS
The variation of average CBFV from time T to T(ΔV) and the variation from time T to T (ΔV) were not obviously different. The median consumption of intraoperative sufentanil in group C was obviously lower than that in group E. At T, the mean HR of group E was significantly higher than that of group C. At T and T, the BP and HR of group E were obviously higher than that of group C. At T, the CBFV in the group E were obviously higher than those in the group C. The incidence of hypotension was significantly reduced in the group E compared with the group C. There were no differences in the other outcomes.
CONCLUSIONS
The induction of esketamine combined with propofol does not increase the blood flow velocity of middle cerebral artery. Esketamine is advantageous in maintaining hemodynamic stability during induction. Furthermore, the administration of esketamine did not result in an increased incidence of adverse effects.
TRIAL REGISTRATION
15/06/2023 clinicaltrials.gov ChiCTR2300072518 https://www.chictr.org.cn/bin/project/edit?pid=176675 .
背景
氯胺酮在临床麻醉中应用日益增多。氯胺酮对大脑中动脉血流速度的影响具有临床指导作用。本研究旨在探讨氯胺酮联合异丙酚全身麻醉诱导用于气管插管对大脑中动脉血流速度和诱导期血流动力学的影响。
方法
本随机临床试验纳入了 2022 年 5 月至 2023 年 5 月在我院行非颅脑择期手术且年龄在 20-65 岁之间的 80 例患者。根据麻醉药物将患者分为两组：舒芬太尼 0.5μg/kg（C 组）或 1.5mg/kg 氯胺酮（E 组）。主要结局为平均脑血流速度的变化值。次要结局包括在四个不同时间点（全身麻醉诱导前（T）、诱导药物注射后 1 分钟（T）、气管插管前（T）和气管插管后 1 分钟（T））的脑血流速度（CBFV）、血压（BP）和心率（HR）。还记录了诱导期间低血压、高血压、流泪和呛咳的发生情况。
结果
从时间 T 到 T（ΔV）的平均 CBFV 变化和从时间 T 到 T（ΔV）的变化差异不明显。C 组术中舒芬太尼的中位消耗量明显低于 E 组。在 T 时，E 组的平均 HR 明显高于 C 组。在 T 和 T 时，E 组的 BP 和 HR 明显高于 C 组。在 T 时，E 组的 CBFV 明显高于 C 组。E 组低血压的发生率明显低于 C 组。其他结果无差异。
结论
氯胺酮联合异丙酚诱导不会增加大脑中动脉的血流速度。氯胺酮有利于维持诱导期间的血液动力学稳定。此外，氯胺酮的给药并未导致不良反应发生率增加。
试验注册
15/06/2023 clinicaltrials.gov ChiCTR2300072518 https://www.chictr.org.cn/bin/project/edit?pid=176675 。
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