亚麻醉剂量艾司氯胺酮对老年腹腔镜直肠癌根治术后康复的影响  

Effect of subanesthetic dose of esketamine on postoperative recovery in elderly patients undergoing laparoscopic radical resection of rectal cancer

作　　者：杨昌建 韩丽 赵月 袁晨 杨芬[1] 谢阳 沈军[2] YANG Chang-jian;HAN Li;ZHAO Yue;YUAN Chen;YANG Fen;XIE Yang;SHEN Jun(Department of Anesthesiology,Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital/Gusu School of Nanjing Medical University,SuzhouJiangsu 215002,China;Department of Bone Surgery,Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou MunicipalHospital/Gusu School of Nanjing Medical University,Suzhou Jiangsu 215002,China)

机构地区：[1]南京医科大学附属苏州医院/苏州市立医院麻醉科/南京医科大学姑苏学院,江苏苏州215002 [2]南京医科大学附属苏州医院/苏州市立医院骨外科/南京医科大学姑苏学院,江苏苏州215002

出　　处：《局解手术学杂志》2024年第9期820-824,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：江苏省自然科学基金(BK20180214);上海闵行区卫生健康委员会科研课题(2023MW69)。

摘　　要：目的探讨亚麻醉剂量艾司氯胺酮用于术后镇痛对老年腹腔镜直肠癌根治术患者早期康复的影响。方法纳入拟行腹腔镜直肠癌根治术的老年患者,采用随机数字表法将患者分为AS组(61例,采用艾司氯胺酮静脉自控镇痛)和SF组(60例,采用舒芬太尼静脉自控镇痛)。比较2组患者手术时间、术中输液量、尿量、术中出血量、术后补救镇痛、术后48 h内患者静脉自控镇痛(PCIA)按压次数和曲马多用量、术后视觉模拟量表(VAS)评分、术后Ramsay镇静评分、术后首次下床活动时间、术后首次排气时间及术后首次进食时间。记录2组患者不良反应发生情况。术毕即刻、术后24 h和72 h采用ELISA法检测2组患者白细胞介素-6(IL-6)和C反应蛋白(CRP)水平。比较2组患者术后3 d、1周和1个月焦虑、抑郁评分。结果2组患者手术时间、术中输液量、尿量、术中出血量、术后补救镇痛、术后48 h内曲马多用量及术后48 h内PCIA按压次数比较,差异均无统计学意义(P>0.05)。2组患者术毕即刻、术后24 h和72 h IL-6、CRP水平逐渐升高(P<0.05),且AS组患者术后24 h和72 h的IL-6、CRP水平均显著低于SF组(P<0.05)。AS组患者术后首次下床活动时间、术后首次排气时间、术后首次进食时间均早于SF组(P<0.05)。AS组患者恶心、呕吐和头晕发生率显著低于SF组(P<0.05)。AS组患者术后24 h和72 h的IL-6和CRP水平均显著低于SF组(P<0.05)。AS组患者术后3 d和术后1周的焦虑和抑郁评分显著低于SF组(P<0.05)。结论亚麻醉剂量艾司氯胺酮用于术后镇痛可减轻老年腹腔镜直肠癌根治术患者术后短期焦虑和抑郁,缓解术后疼痛和炎症反应,不良反应发生率低,有助于患者早期康复。Objective To investigate the effect of subanesthetic dose of esketamine for postoperative analgesia on early recovery in elderly patients undergoing laparoscopic radical resection of rectal cancer.Methods Elderly patients undergoing laparoscopic radical resection of rectal cancer were included,and they were divided into the AS group(61 cases received esketamine for intravenous self-controlled analgesia)and the SF group(60 cases received sufentanil for intravenous self-controlled analgesia)by random number table method.The operation time,intraoperative infusion volume,urine output,intraoperative blood loss,postoperative rescue analgesia,tramadol dosage and the number of patient controlled intravenous analgesia(PCIA)compressions within 48 hours after surgery,postoperative visual analogue scale(VAS)score,Ramsay sedation score,first ambulation time after surgery,first gas passage time after surgery,and first feeding time after surgery were compared between the two groups.The occurrence of adverse reactions in the two groups was recorded.The levels of interleukin-6(IL-6)and C-reactive protein(CRP)immediately after surgery,24 hours and 72 hours after surgery in the two groups were detected by ELISA.The scores of anxiety and depression 3 days,1 week and 1 month after surgery were compared between the two groups.Results There was no significant difference in the operation time,intraoperative infusion volume,urine output,intraoperative blood loss,postoperative rescue analgesia,tramadol dosage or PCIA compressions within 48 hours after surgery between the two groups(P>0.05).The levels of IL-6 and CRP gradually increased immediately after surgery and 24 hours and 72 hours after surgery in the two groups(P<0.05),and the levels of IL-6 and CRP 24 hours and 72 hours after surgery in the AS group were significantly lower than those in the SF group(P<0.05).The first ambulation time after surgery,first gas passage time after surgery,and first feeding time after surgery in the AS group were earlier than those in the SF group(P<0.0

关 键 词：亚麻醉剂量 艾司氯胺酮 老年患者 腹腔镜直肠癌根治术 术后镇痛 早期康复 

分 类 号：R735.34[医药卫生—肿瘤] R614[医药卫生—临床医学]