小剂量艾司氯胺酮对老年患者腹腔镜结肠癌手术中血流动力学、应激反应及术后恢复质量的影响  

Effect of low-dose esketamine on hemodynamics,stress response and postoperative recovery quality in elderly patients undergoing laparoscopic colectomy for colon carcinoma

作　　者：任红 张淑芳 齐贺彬 王东梅 周广伟 孙鹏 贾兆晋 张满和[2] 王英[2] REN Hong;ZHANG Shu-fang;QI He-bin;WANG Dong-mei;ZHOU Guang-wei;SUN Peng;JIA Zhao-jin;ZHANG Man-he;WANG Ying(Department of Anesthesiology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Anesthesiology,Tangshan Gongren Hospital,Hebei Tangshan 063000,China)

机构地区：[1]解放军总医院第一医学中心麻醉科,北京100853 [2]唐山市工人医院麻醉科,河北唐山063000

出　　处：《临床药物治疗杂志》2023年第7期33-38,共6页Clinical Medication Journal

基　　金：河北省卫生健康委医学科研课题(20211730)。

摘　　要：目的观察小剂量艾司氯胺酮对老年患者腹腔镜结肠癌手术中血流动力学、应激反应及术后恢复质量的影响。方法选取2021年1月1日至2022年3月31日唐山市工人医院择期行气管插管全身麻醉下腹腔镜结肠癌手术的老年患者,按随机数字表法分为观察组和对照组。两组麻醉方式均为静吸复合的全身麻醉。麻醉诱导时,观察组静脉输注艾司氯胺酮0.2 mg/kg、舒芬太尼0.2~0.4μg/kg、咪达唑仑0.03~0.06 mg/kg、丙泊酚0.5~1.2 mg/kg、苯磺酸顺式阿曲库铵0.2 mg/kg,对照组静脉输注与观察组艾司氯胺酮等容量生理盐水、舒芬太尼0.2~0.4μg/kg、咪达唑仑0.03~0.06 mg/kg、丙泊酚0.5~1.2 mg/kg、苯磺酸顺式阿曲库铵0.2 mg/kg。观察两组患者麻醉诱导前(T_(0))、诱导后3 min(T_(1))、插管后即刻(T_(2))、手术开始(T_(3))、手术结束(T_(4))5个时点的血流动力学变化情况,并测定T_(0)、T_(2)、T_(3)、T_(4)时血中皮质醇、肾上腺素、去甲肾上腺素水平。选取恢复质量-40(QoR-40)量表评分用于评估患者术后24 h的恢复质量情况。采用数字评价量表(NRS)评分评估术后离开麻醉后恢复室(PACU)前即刻的疼痛情况。结果共纳入76例患者,观察组37例,对照组39例。对照组患者心率(HR)和平均动脉压(MAP)在T_(1)时显著低于T_(0)(P<0.05),在T_(2)、T_(3)、T_(4)时较T_(0)时均显著升高(P<0.05);观察组患者HR及MAP在T_(1)时无明显变化(P>0.05),在T_(2)、T_(3)、T_(4)时显著升高(P<0.05)。观察组患者的HR和MAP在T_(1)时显著高于对照组(P<0.05),HR在T_(2)、T_(3)、T_(4)时,MAP在T_(2)、T_(3)时显著低于对照组(P<0.05);在T_(3)、T_(4)时,观察组患者皮质醇显著低于对照组,肾上腺素、去甲肾上腺素水平在T_(2)、T_(3)、T_(4)时显著低于对照组(P<0.05);观察组患者整体QoR-40评分和情绪状态、疼痛及心理支持3个维度的子评分在术后24 h显著高于对照组(P<0.05);观察组离开PACU前NRS评分显著低于对�Objective To observe the effect of low-dose esketamine on hemodynamics,stress response and postoperative recovery quality in elderly patients undergoing laparoscopic colectomy for colon carcinoma.Methods We selected elderly patients undergoing laparoscopic colectomy for colon carcinoma in the Tangshan Gongren Hospital from January 1,2021 to March 31,2022,and divided them into the observation group and the control group using the random number table method.All subjects were treated with combined intravenous-inhalation anesthesia.During anesthesia induction,the observation group received intravenous injection of esketamine 0.2 mg/kg,sufentanil 0.2 to 0.4μg/kg,midazolam 0.03 to 0.06 mg/kg,propofol 0.5 to 1.2 mg/kg,cisatracurium 0.2 mg/kg,while the control group received an equivalent volume of normal saline with esketamine,sufentanil 0.2 to 0.4μg/kg,midazolam 0.03 to 0.06 mg/kg,propofol 0.5 to 1.2 mg/kg and cisatracurium 0.2 mg/kg.Hemodynamic changes of patients in both groups were recorded at five time points:before anesthesia induction(T_(0)),3 minutes after induction(T_(1)),immediately after intubation(T_(2)),beginning of surgery(T_(3)),and the end of surgery(T_(4)).The levels of cortisol,epinephrine and norepinephrine in the blood were measured at the time points of T_(0),T_(2),T_(3),T_(4).The quality of recovery-40(QoR-40)scoring scale was used to assess the quality of recovery 24 hours after operation.The analgesic effect was evaluated by numerical rating scale(NRS)immediately before leaving the post-anesthesia recovery room(PACU).Results A total of 76 patients were included,with 37 patients in the observation group and 39 patients in the control group.The heart rate(HR)and mean arterial pressure(MAP)of patients in the control group significantly decreased at T_(1) than at T_(0)(P<0.05),and significantly increased at T_(2),T_(3),T_(4) compared to T_(0)(P<0.05).HR and MAP of patients in observation group had no significant changes at T_(1)(P>0.05),but significantly increased at T_(2),T_(3) and T_(4)(P<0.05).H

关 键 词：艾司氯胺酮 老年患者 血流动力学 应激反应 术后恢复质量 

分 类 号：R971.2[医药卫生—药品]