亚麻醉剂量艾司氯胺酮联合肋缘下腹横肌平面阻滞在机器人辅助根治性膀胱切除术患者中的应用效果  

Effect of subanesthetic dose of esketamine combined with subcostal transversus abdominis plane block in patients undergoing robot-assisted radical cystectomy

作　　者：闫岸军 陈治富 马亚芳 YAN Anjun;CHEN Zhifu;MA Yafang(Department of Anesthesiology,Baoji People’s Hospital,Baoji 721000,China)

机构地区：[1]宝鸡市人民医院麻醉科,陕西宝鸡721000

出　　处：《机器人外科学杂志(中英文)》2025年第1期53-59,共7页Chinese Journal of Robotic Surgery

基　　金：陕西省重点研发计划项目(2021SF-265)。

摘　　要：目的:探讨亚麻醉剂量艾司氯胺酮联合肋缘下腹横肌平面阻滞(STAPB)对机器人辅助根治性膀胱切除术(RARC)患者镇痛效果、应激反应、苏醒质量及情绪的影响。方法:选取宝鸡市人民医院于2023年8月—2024年2月行RARC的70例患者,按照随机数字表法分为对照组(给予常规麻醉联合STAPB,35例)和研究组(给予亚麻醉剂量艾司氯胺酮联合STAPB,35例),比较两组临床指标。结果:两组患者术后疼痛数字分级评分法(NRS)评分随着时间变化呈降低趋势,且研究组NRS评分均低于对照组(P<0.05);在术前(T0)、手术开始后10min(T1)、拔管后5 min(T2),两组DBP先降低后升高,T1、T2时研究组DBP高于对照组;研究组SBP先降低后升高,对照组SBP先升高后降低,T1、T2时研究组SBP低于对照组;两组HR先升高后降低,T1、T2时研究组HR低于对照组(P<0.05);研究组苏醒相关时间均短于对照组,拔管后15 min、30 min的Steward苏醒评分表评分高于对照组(P<0.05);术后3 d两组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均降低,各项炎症因子水平均升高,研究组低于对照组(P<0.05);两组患者术后并发症总发生率相比,差异无统计学意义(P>0.05)。结论:RARC患者使用亚麻醉剂量艾司氯胺酮联合STAPB,可减轻机体应激反应和炎症反应,缓解焦虑抑郁症状,苏醒质量较高,且有一定安全性,临床应用效果较好。Objective:To investigate the effects of subanesthetic dose of esketamine combined with subcostal transversus abdominis plane block(STAPB)on the analgesic effect,stress response,awakening quality,and mood of patients undergoing robot-assisted radical cystectomy(RARC).Methods:70 patients who underwent RARC in Baoji People’s Hospital from August 2023 to February 2024 were selected and divided into the control group(conventional anesthesia combined with STAPB,n=35)and the study group(subanesthetic dose of esketamine combined with STAPB,n=35)using a random number table,and the clinical indicators of the two groups were compared.Results:The postoperative pain numerical rating scale(NRS)scores showed a decreasing trend over time in both groups,and the scores of the study group were lower than those of the control group(P<0.05).At the preoperative period(T0),10 minutes after the start of the operation(T1),and 5 minutes after extubation(T2),the diastolic blood pressure(DBP)decreased and then increased in both groups.At T1 and T2,the DBP in the study group was higher than that in the control group.Systolic blood pressure(SBP)in the study group initially decreased and then increased,whereas in the control group it initially increased and then decreased.At T1 and T2,the study group showed lower SBP than that of the control group.In both groups,the heart rate(HR)initially increased and subsequently decreased,it was lower in the study group than the the control group at T1 and T2(P<0.05).The awakening-related time was shorter in the study group,and at 15 and 30 minutes after extubation,the study group got higher Steward’s Awakening Scale scores than the control group(P<0.05).At 3 d after surgery,both groups had lower scores on the self-rating depression scale(SDS)and self-rating anxiety scale(SAS)and increased levels of various inflammatory factors,while it was lower in the study group than that in the control group(P<0.05).There is no statistically significant difference in the total incidence of postoperative complicatio

关 键 词：艾司氯胺酮 肋缘下腹横肌平面阻滞 机器人辅助根治性膀胱切除术 镇痛效果 应激反应 苏醒质量 

分 类 号：R614[医药卫生—麻醉学] R737.14[医药卫生—外科学]