艾司氯胺酮复合腹横肌平面阻滞对腹腔镜胆囊切除术患者术后恢复质量的影响

Effect of esketamine combined with transversus abdominis plane block on recovery quality of laparoscopic cholecystectomy surgery patients

目的 探讨艾司氯胺酮复合腹横肌平面阻滞(TAP)在即将行腹腔镜胆囊切除术(LC)患者术中镇痛及术后质量恢复的影响,明确其临床意义。方法 择期实施LC的患者,年龄40~75岁,采用随机数字表法分成将96例患者分为(QoR)艾司氯胺酮组(S组)33例、TAP+艾司氯胺酮组(TS组)32例和TAP组(T组)31例。S组麻醉诱导时静脉艾司氯胺酮0.125mg/kg,TS组在诱导时静脉艾司氯胺酮0.125mg/kg后,随后行TAP阻滞;T组在麻醉诱导后行TAP阻滞。随后观察患者术后24h的QoR-40以及手术期间阿片类药物和丙泊酚的消耗、NRS评分和术后2d恶心呕吐(post-operative nausea and vomiting,PONV)的发生率。结果 TS组的整体QoR-40评分和情绪状态和疼痛以及自理能力三个维度的子评分在术后24h显着高于S组和T组,另外术后4、8、24h,TS组的NRS评分显着低于S组和T组(P<0.05)术后0.5、4、8h,TS的Ramsay比S组和T组评分低且差异有统计学意义。结论 本研究结果表明小剂量艾司氯胺酮复合TAP提高了术后质量恢复并减轻术后疼痛。

Objective To explore the effect of esketamine combined with transversus abdominis plane block(TAP)on intraoperative analgesia and postoperative quality of recovery among patients undergoing laparoscopic cholecystectomy(LC).Methods A total of 96 patients at 40-75 years of age undergoing LC were randomly divided into three groups:esketamine group(group S,n=33),TAP group(group T,n=31),and esketamine+TAP group(group TS,n=32).Patients in the group S and the group TS received 0.125 mg/kg esketamine immediately following the induction of anesthesia.Patients in the group T and the group TS received TAP block after induction of anesthesia.Observations included QoR-40 at postoperative 24 h,intraoperative opioid and propofol consumption,NRS score,and the incidence of post-operative nausea and vomiting(PONV) at postoperative 2 d.Results Compared with group S and group T,global QoR-40 scores and the dimensional scores of emotional state,pain,and physical independence were significantly higher in the group TS at postoperative 24 h,and the NRS score of the group TS was significantly lower than those in the group S and the group T at postoperative 4,8,and 24 h(P<0.05).The Ramsay score of the group TS was significantly lower than those in the group S and the group T at postoperative 0.5,4,and 8 h(P<0.05).Conclusion Small doses of ketamine in addition to TAP can improve the quality of recovery and reduce postoperative pain.