艾司氯胺酮复合超声引导下星状神经节阻滞对老年结直肠切除术患者应激反应和术后免疫功能的影响  

Effects of esketamine combined with ultrasound-guided stellate ganglion block on stress response and postoperative immune function in elderly patients undergoing enterectomy

作　　者：冯秀梅 毛姗姗 胡蕊 高巨 FENG Xiumei;MAO Shanshan;HU Rui;GAO Ju(Yangzhou University Medicine Academy,Yangzhou 225000,China;Department of Anesthesiology,Xuzhou Hospital of Traditional Chinese Medicine,Nanjing University of Chinese Medicine,Xuzhou 221000,China;Department of Anesthesiology,Clinical Medical School of Yangzhou University Northern Jiangsu People's Hospital,Yangzhou 225000,China)

机构地区：[1]扬州大学医学院,扬州225000 [2]南京中医药大学附属徐州市中医院麻醉科,徐州221000 [3]扬州大学临床医学院江苏省苏北人民医院麻醉科,扬州225000

出　　处：《中国免疫学杂志》2025年第2期393-397,共5页Chinese Journal of Immunology

基　　金：国家自然科学基金面上项目(82172190)。

摘　　要：目的:探讨艾司氯胺酮复合超声引导下星状神经节阻滞(SGB)对老年结直肠切除术患者应激反应和术后免疫功能的影响。方法:回顾性分析2020年9月至2022年4月南京中医药大学附属徐州市中医院进行结直肠切除术的70例老年患者的临床资料,随机分为观察组和对照组(各35例),对照组给予超声引导下SGB,观察组给予艾司氯胺酮复合超声引导下SGB。比较两组患者SGB前5 min(t_(0))、气管插管即刻(t_(1))、手术1 h(t_(2))和术毕(t_(3))时心率(HR)、平均动脉压(MAP)、心率与收缩压的乘积(RPP)、应激反应水平[皮质醇(CORT)、SOD、MDA、IL-6、TNF-α、IL-1β],比较t_(0)、t_(3)、术毕24 h(t_(4))、术后72 h(t5)CD3^(+)T、CD4^(+)T、CD8^(+)T和CD4^(+)T/CD8^(+)T,比较两组患者苏醒时间、首次排气时间、肠鸣音恢复时间和首次经口进食时间、麻醉期间不良反应情况。结果:两组患者不同时间点HR、MAP、RBP、CORT、SOD、MDA、IL-6、TNF-α、IL-1β、CD3^(+)T、CD4^(+)T、CD8^(+)T和CD4^(+)T/CD8^(+)T经重复测量方差分析比较,组间和不同时间点差异显著(P<0.05);与对照组比较,观察组苏醒时间、首次排气时间、肠鸣音恢复时间和首次经口进食时间均、术后下床时间更短(P<0.05),术中止疼药用量更少(P<0.05),麻醉期间不良反应发生率更低[48.57%(17/35) vs 25.71%(9/35),P<0.05]。结论:对老年肠切除术患者进行艾司氯胺酮复合超声引导下SGB可促进术后胃肠道功能恢复,减轻围手术期应激反应,对患者免疫功能影响较小,可减少围手术期不良反应。Objective:To investigate effect of esketamine combined with ultrasound-guided stellate ganglion block(SGB)on stress response and postoperative immune function in elderly patients undergoing colorectal resection.Methods:A retrospective analysis was conducted in clinical data from 70 cases of elderly patients undergoing elective colorectal resection in Xuzhou Hospital of Traditional Chinese Medicine,Nanjing University of Chinese Medicine from September 2020 to April 2022,who were randomly divided into observation group(n=35)and control group(n=35),control group was treated with ultrasound-guided SGB,observation group was treated with esketamine combined ultrasound-guided SGB.Heart rate(HR),mean arterial pressure(MAP),product of heart rate and systolic blood pressure(RPP)and stress response levels[cortisol(CORT),SOD,MDA,IL-6,TNF-α,IL-1β]were compared between two groups at 5 min before SGB(t_(0)),immediately after tracheal intubation(t_(1)),1 h after operation(t_(2))and end of operation(t_(3)).CD3^(+)T,CD4^(+)T,CD8^(+)T and CD4^(+)T/CD8^(+)T at t_(0),t_(3),24 h after operation(t_(4))and 72 h after operation(t5)were compared,respec‐tively.Recovery time,first exhaust time,bowel sound recovery time and first oral feeding time and incidence of adverse reactions during anesthesia were compared between two groups.Results:HR,MAP,RPP,CORT,SOD,MDA,IL-6,TNF-α,IL-1β,CD3^(+)T,CD4^(+)T,CD8^(+)T and CD4^(+)T/CD8^(+)T at different time points in two groups were compared by repeated measures analysis of variance,and there were significant differences between groups and at different time points(P<0.05).Compared with control group,observation group had shorter recovery time,first exhaust time,bowel sound recovery time,first oral feeding time,postoperative time out of bed(P<0.05),and less intraoperative pain medication consumption,incidence of adverse reactions during anesthesia was reduced[48.57%(17/35)vs 25.71%(9/35),P<0.05].Conclusion:Esketamine combined with ultrasound-guided SGB in elderly patients undergoing enterectomy can

关 键 词：艾司氯胺酮 超声引导下星状神经节阻滞 肠切除术 应激反应 免疫应答 

分 类 号：R614[医药卫生—麻醉学]