Abstract: Objective　To observe the effect of esketamine in induction of general anesthesia for lumbar surgery on hemodynamics and the extubation period. Methods　A total of 60 patients [American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ] who were scheduled to undergo lumbar surgery under general anesthesia at 970th Hospital of the PLA were enrolled in this study. They were divided into an esketamine group (group E) and a fentanyl group (group F) by the random number table method, with 30 cases in each group. There were 16 males and 14 females in group E, and they were (58.0±7.5) years old. There were 18 males and 12 females in group F, and they were (57.4±7.2) years old. During induction of anesthesia, etomidate 0.3 mg/kg and atracurium 0.3 mg/kg were intravenously injected in all the patients, and group E took esketamine 0.5 mg/kg and group F took fentanyl 5 μg/kg. The hemodynamic changes, such as heart rate (HR) and mean arterial pressure (MAP), were observed and recorded before anesthesia induction (T0), immediately before endotracheal intubation (T1), and 1 min (T2) and 5 min (T3) after intubation. The extubation times and accurate activity times of both lower limbs, and postoperative adverse reactions in both groups were recorded. One-way ANOVA, t test, and χ² test were applied. Results　There were no statistical differences in HR and MAP between two groups at T0 (both P>0.05). The MAP's in group E [(90.5±7.9) mmHg vs. (99.6±8.2) mmHg] and group F [(89.0±9.8) mmHg vs. (97.5±5.7) mmHg] at T1 were significantly lower than those at T0 (both P<0.05). The MAP recovered rapidly in group E after endotracheal intubation, and the MAP's at T2 [(101.4±10.9) mmHg] and T3 [(99.5±7.3) mmHg] were not statistically different from that at T0 (both P>0.05). The MAP's at T2 [(91.5±6.9) mmHg] and T3 [(92.1±7.9) mmHg] of group F were significantly lower than that at T0 (both P<0.05). After induction of anesthesia, the HR at T1 [(61.4±7.5) beats/min] was significantly lower and the HR at T3 [(73.1 ±10.1) beats/min] was significantly higher than that at T0 [(67.7±10.7) beats/min] in group F (both P<0.05). There were no significant changes in HR of group E (all P>0.05). The postoperative extubation time and accurate activity time of both lower limbs in group E were significantly shorter than those in group F [(10.3±0.8) min vs. (13.5±1.5) min and (7.9±2.3) min vs. (9.1±2.8) min], with statistical differences (both P<0.05). The incidence of agitation during waking period of postoperative in group E was significantly lower than that in group F [3.33% (1/30) vs. 20.00% (6/30)]. Conclusion　Esketamine for induction of anesthesia is benificial to stable hemodynamic change and recovery of postoperative cognitive function and could reduce the incidence of adverse reactions such as agitation during the waking period.

Key words: Esketamine, General anesthesia, Anesthesia induction, Hemodynamics, Lumbar surgery

摘要： 目的　观察艾司氯胺酮麻醉诱导对血流动力学、腰椎手术术后拔管期的影响，探讨艾司氯胺酮麻醉诱导的临床效果。方法　选择解放军第970医院择期全身麻醉下行腰椎手术的患者60例，美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级标准Ⅰ～Ⅱ级，采用随机数字法分为艾司氯胺酮组（E组）和芬太尼组（F组），各30例。E组男16例，女14例，年龄（58.0±7.5）岁；F组男18例，女12例，年龄（57.4±7.2）岁。麻醉诱导时，所有患者均静脉注射依托咪酯0.3 mg/kg、苯磺酸顺阿曲库铵0.3 mg/kg，E组伍用艾司氯胺酮0.5 mg/kg，F组伍用芬太尼5 μg/kg行麻醉诱导气管插管。观察并记录两组患者麻醉诱导前（T0）、诱导后气管插管前即刻（T1）、插管完成后1 min（T2）、5 min（T3）心率（heart rate，HR）和平均动脉压（mean arterial pressure，MAP）等血流动力学变化、术后拔管时间、术后准确活动双下肢时间及不良反应情况。采用单因素方差分析、独立样本t检验和χ²检验。结果　两组患者T0时HR、MAP比较，差异均无统计学意义（均P>0.05）；两组患者T1时MAP较T0时均显著降低［E组（90.5±7.9）mmHg（1 mmHg=0.133 kPa）比（99.6±8.2）mmHg、F组（89.0±9.8）mmHg比（97.5±5.7）mmHg，均P<0.05］；气管插管后，E组患者MAP快速回升，T2［（101.4±10.9）mmHg］、T3［（99.5±7.3）mmHg］时点同T0时比较，差异均无统计学意义（均P>0.05）；F组患者T2［（91.5±6.9）mmHg］、T3［（92.1±7.9）mmHg］时同T0时比较仍显著降低，差异均有统计学意义（均P<0.05）。麻醉诱导后，F组患者HR波动较为明显，T1时［（61.4±7.5）次/min］较T0时［（67.7±10.7）次/min］显著降低，插管后T3时［（73.1±10.1）次/min］较T0时显著升高，差异均有统计学意义（均P<0.05）；E组患者各时点HR均无显著变化（均P>0.05）。E组患者术后拔管时间及拔管后准确活动双下肢时间均显著低于F组［（10.3±0.8）min比（13.5±1.5）min、（7.9±2.3）min比（9.1±2.8）min］，差异有统计学意义（均P<0.05）。E组患者苏醒期躁动不良反应发生率显著低于F组［3.33%（1/30）比20.00%（6/30）］，差异有统计学意义（P<0.05）。结论　艾司氯胺酮麻醉诱导有利于患者血流动力学稳定及术后认知功能恢复，降低苏醒期躁动等不良反应发生率。

关键词: 艾司氯胺酮, 全身麻醉, 麻醉诱导, 血流动力学, 腰椎手术