术中输注小剂量氯胺酮对腹腔镜全子宫切除术患者术后疲劳的影响

Effect of low dose of ketamine on postoperative fatigue in patients undergoing laparoscopic hysterectomy

目的研究术中输注小剂量氯胺酮(ketamine,Ket)对腹腔镜全子宫切除术患者术后疲劳(postoperative fatigue,POF)的影响。方法择期在全身麻醉下行妇科腔镜全子宫切除手术的患者90例,按随机数字表法分为Ket组(K组)和对照组(N组),每组45例。K组患者诱导后予Ket 0.5 mg/kg缓慢静脉注射,随后以0.25 mg•kg^-1•h^-1泵注至手术结束,N组按同样方法予等体积的生理盐水。使用疲劳量表-14(Fatigue Scale-14,FS-14)评分评价患者POF发生情况。主要观察指标:两组患者术后3、7 d及30 d的FS-14评分及POF发生率。次要观察指标:术中心率、MAP,术后VAS评分,拔管后Ramsay镇静评分及恶心呕吐等不良反应发生情况。结果与N组比较,K组术后3 d的FS-14评分及POF发生率明显较低(P<0.05),K组术后7 d及30 d的FS-14评分及POF发生率差异无统计学意义(P>0.05)。与N组比较,K组患者拔管后Ramsay镇静评分明显较高(P<0.05)。与N组比较,K组患者术后3、7 d VAS评分明显降低(P<0.05)。两组患者术后30 d VAS评分比较,差异无统计学意义(P>0.05)。两组患者术中心率、MAP及术后恶心呕吐等不良反应发生率比较,差异无统计学意义(P>0.05)。结论术中使用小剂量Ket可以降低妇科腔镜手术患者术后3 d POF发生率,且具有良好的镇静、镇痛作用。

Objective To investigate the effect of intraoperative infusion of low‑dose ketamine(Ket)on postoperative fatigue(POF)in patients undergoing laparoscopic hysterectomy.Methods Ninety patients scheduled to gynecological laparoscopic hyster‑ectomy were divided into two groups(n=45),according to the random number table method:Ket group(group K)and control group(group N).Patients in group K were given Ket 0.5 mg/kg after induction of anesthesia,then at an infusion rate of 0.25 mg·kg^−1·h^−1 until the end of surgery.Group N was given the same volume of saline solution with the same method.The occurrence of POF was evaluated by Fatigue Scale‑14(FS‑14)score.The primary indexes were FS‑14 scores and the incidences of POF at 3,7 and 30 d after surgery.The secondary indexes included intraoperative heart rate,mean arterial pressure(MAP),postoperative Visual Analogue Scale(VAS)scores,Ramsay scores after extubation,and adverse reactions such as nausea and vomiting.Results Compared with the group N,the incidence of POF and FS‑14 score in group K were significantly lower at 3 d after surgery(P<0.05).Compared with the group N,there was no significant difference in FS‑14 score and incidence of PDF at 7 d and 30 d after operation in group K(P<0.05).Ramsay scores after extubation in group K were also significantly higher than in group N(P<0.05).Patients in group K showed significantly low‑er VAS scores at 3 and 7 d after surgery(P<0.05).There was no significant difference in VAS scores between the two groups at 30 d af‑ter operation(P>0.05).There were no significant differences in adverse events such as intraoperative heart rate and MAP,nausea and vomiting between the two groups(P>0.05).Conclusions Intraoperative use of low‑dose ketamine can reduce the incidence of fa‑tigue in patients undergoing gynecologic laparoscopic surgery at 3 d after surgery,with a good sedative and analgesic effect.