静脉注射艾司氯胺酮联合全身麻醉在腹腔镜胆囊切除术患者中的应用

Application of intravenous esketamine combined with general anaesthesia in the patients undergoing laparoscopic cholecystectomy

目的 探讨静脉注射艾司氯胺酮联合全身麻醉对腹腔镜胆囊切除术患者的影响。方法 选取2019年10月至2021年9月如皋市人民医院收治的124例腹腔镜胆囊切除术患者为研究对象,采用数字表法随机分为对照组(常规全身麻醉,62例)和研究组(全身麻醉+静脉注射艾司氯胺酮,62例)。对比2组患者手术相关指标、血流动力学及视觉疼痛模拟(VAS)评分。对比2组术后麻醉相关不良反应发生情况。结果 2组患者手术时间、术中补液量对比,差异无统计学意义(P>0.05);研究组术后舒芬太尼用量少于对照组(P<0.05)。术后1 h 2组患者心率(HR)、收缩压(SBP)、舒张压(DBP)低于术前30 min(P<0.05);术后6 h 2组患者HR、SBP、DBP高于术前30 min和术后1 h(P<0.05);研究组术后6 h、术后12 h HR、SBP、DBP均低于对照组(P<0.05)。2组患者术后6 h和术后12 h VAS评分均高于术后1 h(P<0.05),术后12 h VAS评分均高于术后6 h(P<0.05);研究组术后1 h、6 h和12 h VAS评分均低于对照组(P<0.05)。2组患者术后麻醉相关不良反应总发生率对比,差异无统计学意义(P>0.05)。结论 腹腔镜胆囊切除术患者在全身麻醉的基础上另给予静脉注射艾司氯胺酮麻醉可减少术后阿片类药物的用量、减轻血流动力学波动、缓解术后疼痛,且安全可靠。

Objective To investigate the effects of intravenous esketamine combined with general anaesthesia in the patients undergoing laparoscopic cholecystectomy.Methods A total of 124 patients who were admitted to Rugao People’s Hospital from October 2019 to September 2021 undergoing laparoscopic cholecystectomy were selected as research subjects,and were equally divided into the control group(treated with conventional general anesthesia,n=62) and the study group(treated with general anesthesia plus esketamine,n=62) by random number table method.Surgery-related indexes,hemodynamics and visual pain simulation(VAS) scores were compared between the 2 groups.The rates of postoperative anesthesia-related adverse reactions in the two groups were also compared.Results There were no significant differences in surgical time and intraoperative fluid supplement,when comparisons were made between the 2 groups(P>0.05),with the consumption amount of sufentanil in the study group being less than that of the control group(P<0.05).Two hours after surgery,the heart rate,the systolic blood pressure(SBP),the diastolic blood pressure(DBP) in the 2 groups were all lower than those 30 minutes before surgery(P<0.05).Six hours after surgery,the HR,SBP and DBP were all higher than those 30 minutes before surgery and one hour after surgery(P<0.05).The HR,SBP and DBP in the study group 6 hours after surgery and 12 hours after surgery were all less than those in the control group(P<0.05).The VAS scores 6 and 12 hours after surgery in both groups were all higher than those 1 hour after surgery(P<0.05).The VAS scores in both groups 12 hours after surgery were all higher than those 6 hour after surgery(P<0.05).The VAS scores of the study group one,6 and12 hours after surgery were all lower than those within the same time span in the control group(P<0.05).There was no statistical significance in the rate of postoperative anesthesia-related adverse reactions,when comparisons were made between the two groups(P>0.05).Conclusion Intravenous esketamine anesthesia combined with general anesthesia in the patients undergoing laparoscopic cholecystectomy could reduce postoperative opioid consumption,alleviate hemodynamic fluctuation and postoperative pain,with good safety and reliability.