艾司氯胺酮雾化吸入对老年病人全麻诱导舒芬太尼所致咳嗽的影响

doi:10.3969/j.issn.1003-9198.2025.10.014

摘要/Abstract

摘要： 目的评价术前艾司氯胺酮雾化吸入对老年病人全麻诱导舒芬太尼所致咳嗽(SIC)的发生率以及严重程度的影响。方法选择南京医科大学附属老年医院2023年4月至2024年4月择期行气管插管全麻手术的老年病人102例,随机分为对照组和艾司氯胺酮组。艾司氯胺酮组病人术前给予艾司氯胺酮雾化,对照组病人术前接受0.9%生理盐水雾化。记录2组麻醉诱导注射舒芬太尼后1 min内SIC的发生率及头晕、恶心呕吐、胸闷、呼吸抑制的情况;观察并比较预处理开始前(T₀)、开始后2 min (T₁)、插管时(T₂)及插管后2 min (T₃)的心率(HR)和平均动脉压(mean arterial pressure,MAP);记录拔管时间、麻醉后监护室(PACU)期间不良事件(躁动、呼吸抑制、麻醉苏醒延迟、术后恶心呕吐)发生率及拔管后30 min咽喉疼痛和声音嘶哑发生率。结果艾司氯胺酮组病人注射舒芬太尼后1 min内SIC发生率及轻、中度咳嗽发生率均明显低于对照组(P<0.05)。2组病人在T₀~T₃时HR、MAP未见明显差异(P＞0.05)。与对照组相比,艾司氯胺酮组拔管后30 min 咽痛及声嘶发生率明显降低(P<0.05)。2组注射舒芬太尼后1 min内头晕、恶心呕吐、胸闷和呼吸抑制、PACU期间不良事件的发生率及拔管时间的差异均无统计学意义(P > 0.05)。结论术前艾司氯胺酮雾化吸入能显著降低麻醉诱导时SIC的发生率和严重程度、减少术后咽痛和声嘶发生率,同时不增加阿片类药物相关不良反应及PACU期间不良事件,且对术中血流动力学稳定性和术后麻醉苏醒无明显影响。

关键词: 艾司氯胺酮, 雾化吸入, 舒芬太尼, 咳嗽, 老年人

Abstract: Objective To evaluate the effect of preoperative nebulized esketamine on the incidence and severity of sufentanil-induced cough(SIC)during general anesthesia induction in the elderly. Methods A total of 102 elderly patients scheduled for elective tracheal intubation and general anesthesia surgery at Geriatric Hospital of Nanjing Medical University from April 2023 to April 2024 were enrolled and randomly divided into control group and esketamine group. The esketamine group received esketamine nebulization before surgery, while the control group received 0.9% saline nebulization. The incidence and severity of SCI, dizziness, nausea, vomiting, chest tightness, and respiratory depression within 1 minute after sufentanil injection for anesthesia induction were recorded. Heart rate(HR) and mean arterial pressure(MAP) were observed and compared before pre-treatment (T₀), 2 minutes after pre-treatment (T₁), at intubation (T₂), and 2 minutes after intubation (T₃).The time of extubation and the incidence of adverse events in the postanesthesia care unit(PACU) such as agitation, respiratory depression, delayed recovery from anesthesia, postoperative nausea and vomiting(PONV), sore throat and hoarseness 30 minutes after extubation were recorded. Results In the esketamine group, the incidence rates of SCI and mild to moderate cough within 1 minute after sufentanil injection were significantly lower than those in the control group (P<0.05). There were no significant differences in HR and MAP between the two groups at T₀-T₃ (P>0.05). Compared with the control group, the incidence rates of sore throat and hoarseness 30 minutes after extubation in the esketamine group were significantly decreased (P<0.05).There were no significant differences in the incidence rates of dizziness, nausea, vomiting, chest tightness, respiratory depression within 1 minute after sufentanil injection, adverse events in the PACU, and extubation time between the two groups (P>0.05). Conclusions Preoperative esketamine nebulization can significantly reduce the incidence and severity of SIC during anesthesia induction, reduce the incidence rates of postoperative sore throat and hoarseness, without increasing the adverse reactions related to opioids and adverse events during PACU, and has no significant effect on intraoperative hemodynamic stability and postoperative anesthesia awakening.

Key words: esketamine, nebulized inhalation, sufentanil, cough, aged

中图分类号:

R 453

蒲文汉, 杨雯, 徐宁, 曹青, 程浩. 艾司氯胺酮雾化吸入对老年病人全麻诱导舒芬太尼所致咳嗽的影响[J]. 实用老年医学, 2025, 39(10): 1038-1042.

PU Wenhan, YANG Wen, XU Ning, CAO Qing, CHENG Hao. Effect of preoperative esketamine nebulization on sufentanil-induced cough during general anesthesia induction in elderly patients[J]. Practical Geriatrics, 2025, 39(10): 1038-1042.

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