艾司氯胺酮对腹腔镜结直肠癌根治术老年患者术后疼痛及神经认知紊乱的影响  

Effect of Esketamine on Postoperative Pain and Neurocognitive Disorder in Elderly Patients Undergoing Laparoscopic Colorectal Cancer Radical Surgery

作　　者：雷宇[1] 王茜[1] 宋世雄 李明 张博林[1] 王能勇[1] Lei Yu;Wang Qian;Song Shixiong(Department of Anesthesiology,Clinical Laboratory,Guangyuan Central Hospital,Guangyuan,Sichuan 628000,China)

机构地区：[1]广元市中心医院麻醉科,检验科,四川广元628000

出　　处：《四川医学》2023年第7期697-701,共5页Sichuan Medical Journal

基　　金：四川省国际医学交流促进会基金项目(编号:L20200509022)。

摘　　要：目的 探讨艾司氯胺酮对腹腔镜结直肠癌根治术老年患者术后疼痛及神经认知紊乱的(PND)影响。方法选择拟行腹腔镜结直肠癌根治术的老年患者120例,按照随机数字表法将患者分为E_(1)组、E_(2)组及C组,每组40例。3组麻醉方法相同。麻醉诱导后E_(2)组静脉注射艾司氯胺酮0.25 mg/kg, E_(1)组与C组静脉注射等量生理盐水。术后行静脉自控镇痛,镇痛液配方:3组舒芬太尼2.5μg/kg、格拉司琼6 mg加入生理盐水稀释至150 ml, E_(1)组、E_(2)组另加艾司氯胺酮0.75 mg/kg。背景剂量3 ml/h,单次剂量2 ml,锁定时间30 min。记录3组术前(T_(0))、术后2 h(T_(1))、12 h(T_(2))、24 h(T_(3))、72 h(T_(4))、 7 d(T_(5))视觉模拟评分(VAS评分)。记录3组在T_(1)、T_(2)、T_(5)时神经认知紊乱发生例数及术后不良反应的发生情况。于T_(0)、T_(1)、T_(5)时分别抽取静脉血2 ml,采用酶联免疫吸附法(ELISA)测定血清中的IL-6和TNF-α水平。结果 3组VAS评分在时间、组间以及时间与组间交互作用比较差异有统计学意义(P<0.05)。组内与T_(0)比较,3组在T_(4)、T_(5)时VAS评分升高,E_(1)组和C组在T_(2)、T_(3)时VAS评分升高(P<0.01)。组间与C组比较,E_(1)组在T_(3)时、E_(2)组在T_(3)-T_(5)时VAS评分下降(P<0.01);与E_(1)组比较,E_(2)组在T_(4)时VAS评分下降(P<0.01)。与C组比较,E_(2)组在T_(1)、T_(2)及T_(5)神经认知紊乱发生率下降(P<0.05)。3组术后低血压、高血压、窦性心动过缓、恶心呕吐及皮肤瘙痒等不良反应比较差异无统计学意义(P>0.05),3组术后均未发现呼吸抑制病例。3组IL-6及TNF-α水平在时间、组间以及时间与组间交互作用比较差异有统计学意义(P<0.05)。组内与T_(0)比较,3组在T_(1)、T_(5)时IL-6及TNF-α水平升高(P<0.01)。与T_(1)比较,3组在T_(5)时IL-6及TNF-α水平下降(P<0.01)。组间与C组和E_(1)组比较,E_(2)组在T_(1)、T_(5)时IL-6及TNF-α水平下降(P<0.01)。结论艾司氯胺酮可减轻腹�Objective To study the effects of Esketamine on postoperative pain and neurocognitive disorder(PND)in elderly patients undergoing laparoscopic colorectal cancer radical surgery.Methods 120 elderly patients who were scheduled to undergo laparoscopic colorectal cancer radical surgery were randomly divided into group E_(1),E_(2) and C,with 40 cases in each group.The anesthesia methods of three groups were the same.After induction,group E_(2) was injected with 0.25 mg/kg of Esketamine intravenously,and group E_(1) and group C were injected with the same amount of normal saline.Postoperative patient-controlled intravenous analgesia was performed with a formula:sufentanil 2.5μg/kg,granisetron 6 mg was diluted to 150 ml with normal saline,and Esketamine 0.75 mg/kg was added in group E_(1) and group E_(2),with a background dose 3 ml/h,single dose 2 ml,locking time 30 min.The visual analog scores(VAS scores)were recorded before operation(T_(0)),2 hours after operation(T_(1)),12 hours(T_(2)),24 hours(T_(3)),72 hours(T_(4)),and 7 days(T_(5)).The number of cases of PND in T_(1),T_(2) and T_(5) and the incidence of adverse reactions after operation was recorded.2 ml of venous blood was collected at T_(0),T_(1) and T_(5),respectively,and IL-6 and TNF-αin serum were determined by enzyme-linked immunosorbent assay(ELISA).Results The VAS scores of three groups were significantly different in time,between groups,and interaction between time and groups(P<0.05).In group comparison,compared with T_(0),VAS scores of three groups were increased at T_(4) and T_(5),while VAS scores of group E_(1) and group C were increased at T_(2) and T_(3)(P<0.01).Compared with group C,VAS scores of group E_(1) at T_(3) and group E_(2) at T_(3)-T_(5) were decreased(P<0.01).Compared with group E_(1),VAS score of group E_(2) was decreased at T_(4)(P<0.01).Compared with group C,incidences of PND in group E_(2) were decreased at T_(1),T_(2) and T_(5)(P<0.05).There was no significant difference in adverse reactions such as hypotension,hypertension,sinus b

关 键 词：氯胺酮 镇痛 神经认知障碍 老年人 

分 类 号：R619[医药卫生—外科学] R735.3[医药卫生—临床医学]