艾司氯胺酮联合右美托咪定麻醉前处理对腹腔镜胆囊切除术治疗胆囊结石患者术后睡眠质量和情绪状态的影响  

Pretreatment of esketamine and dexmedetomidine in patients with cholecystolithiasis undergoing laparoscopic cholecystectomy

作　　者：张莹萱 王艺倩 解成兰 姚程亮 王军 Zhang Yingxuan;Wang Yiqian;Xie Chenglan(Department of Anesthesiology,Huai'an Hospital Affiliated to Xuzhou Medical University,Huai'an 223002,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属淮安医院麻醉科,江苏省淮安市223002

出　　处：《实用肝脏病杂志》2025年第2期310-313,共4页Journal of Practical Hepatology

基　　金：江苏省卫生健康委科研项目(编号:Z2020080)。

摘　　要：目的探讨应用艾司氯胺酮与右美托咪定联合预处理对腹腔镜胆囊切除术(LC)治疗的胆囊结石患者术后睡眠质量和情绪的影响。方法2022年11月~2024年4月我院收治的113例胆囊结石患者,均接受LC术治疗。在麻醉前,被随机分为D组(n=37)、ED组(n=38)和C组(n=38),分别给予右美托咪定、右美托咪定联合艾司氯胺酮和生理盐水静脉泵注。常规行麻醉诱导和维持。采用Athens失眠量表(AIS)和匹兹堡睡眠指数量表(PSQI)评估睡眠质量,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估情绪状态,采用疼痛数字评定量表(NRS)和Ramsay镇静量表评估镇痛和镇静效果。结果在术后第1天(POD1)和POD3时,ED组AIS评分分别为(8.4±1.3)分和(6.8±1.4)分,显著低于D组【分别为(8.7±1.1)分和(6.9±1.7)分,P<0.05】或C组【分别为(9.7±1.1)分和(8.5±1.1)分,P<0.05】,PSQI评分分别为(9.1±1.3)分和(7.7±1.5)分,显著低于D组【分别为(9.2±1.5)分和(7.9±1.4)分,P<0.05】或C组【分别为(10.9±2.3)分和(8.9±1.8)分,P<0.05】;在POD1时,ED组和D组SAS和SDS评分均显著低于C组,且ED组显著低于D组,差异具有统计学意义(P<0.05);在拔管时、术后24 h和术后72 h,ED组和D组NRS评分均显著低于C组,且ED组显著低于D组,差异具有统计学意义(P<0.05);ED组镇痛泵药物消耗量显著少于D组或C组(P<0.05)。结论麻醉前给予艾司氯胺酮联合右美托咪定预处理可以减轻LC术后患者疼痛,缓解抑郁焦虑情绪,提高术后睡眠质量。Objective This study aimed to investigate analgesia and sedation effects of pretreatment of esketamine and dexmedetomidine in patients with cholecystolithiasis undergoing laparoscopic cholecystectomy(LC).Methods 113 patients with cholecystolithiasis were encountered in our hospital between November 2022 and April 2024,and all underwent LC.Before anesthesia,patients were randomly divided into group D(n=37),group ED(n=38)and group C(n=38)to receive intravenous pumping of dexmedetomidine,esketamine and dexmedetomidine or normal saline for pretreatment.Postoperative sleep quality was assessed by Athens insomnia scale(AIS)and Pittsburgh sleep quality index(PSQI),emotional state was evaluated by self-rating anxiety scale(SAS)scores and self-rating depression scale(SDS)scores,postoperative pain was evaluated by NRS scores,and sedative effect was evaluated by Ramsay scores.Results At postoperative day 1(POD1)and POD3,AIS and PSQI scores in group ED were(8.4±1.3)points and(6.8±1.4)points,both much lower than[(8.7±1.1)points and(6.9±1.7)points,P<0.05]in group D or[(9.7±1.1)points and(8.5±1.1)points,P<0.05]in group C,PSQI scores were(9.1±1.3)points and(7.7±1.5)points,both much lower than[(9.2±1.5)points and(7.9±1.4)points,P<0.05]in group D or[(10.9±2.3)points and(8.9±1.8)points,P<0.05]in group C;at POD1,SAS and SDS scores in group ED and group D were much lower than in group C(P<0.05);at extubation,24 hours and 72 hours after operation,NRS scores in group ED and group D were much lower than in group C(P<0.05);dose of sufentanil given for analgesia after operation in group ED was much smaller than in group D or group C(P<0.05).Conclusion Pretreatment of esketamine and dexmedetomidine in patients with cholecystolithiasis undergoing LC could effectively alleviate postoperative pain,relieve depression and anxiety,and thereby enhance overall postoperative sleep quality.

关 键 词：胆囊结石 腹腔镜胆囊切除术 艾司氯胺酮 右美托咪定 麻醉 睡眠质量 情绪 

分 类 号：R614[医药卫生—麻醉学]