不同剂量艾司氯胺酮对老年胃癌患者术后镇痛及认知功能的影响

Effects of different doses of esketamine on postoperative analgesia and cognitive function in elderly patients with gastric cancer

目的探讨不同剂量艾司氯胺酮对老年胃癌患者术后镇痛及认知功能的影响。方法选取2020年11月至2022年3月宁德人民医院麻醉科收治的150例老年胃癌患者作为研究对象,按照随机数字表法分为A组、B组、C组,每组各50例。A组给予0.3 mg/kg艾司氯胺酮,B组给予0.5 mg/kg艾司氯胺酮,C组给予1.0 mg/kg艾司氯胺酮,三组其他麻醉方法相同。观察三组的麻醉相关指标、生命体征、术后疼痛评分、认知功能以及不良反应。结果B组、C组麻醉起效、呼之睁眼、定向力恢复、意识恢复的时间均短于A组,差异有统计学意义(P<0.05)。B组、C组手术开始时、手术15 min时、术毕时的心率、平均动脉压均高于A组,差异有统计学意义(P<0.05)。B组、C组术后2、6、12、24 h的疼痛评分均低于A组,差异有统计学意义(P<0.05);B组、C组术后1、2 d的认知功能评分均高于A组,差异有统计学意义(P<0.05)。B组与C组麻醉起效、呼之睁眼、定向力恢复、意识恢复的时间及不同时间点的心率、平均动脉压、疼痛评分、认知功能评分比较,差异无统计学意义(P>0.05)。三组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论0.5 mg/kg艾司氯胺酮用于老年胃癌患者术后镇痛已可取得满意的效果,且患者术中生命体征稳定,认知功能损伤轻微,不良反应少,可推广、应用。

Objective To investigate the effects of different doses of Esketamine on postoperative analgesia and cognitive function in elderly patients with gastric cancer.Methods From November 2020 to March 2022,150 elderly patients with gastric cancer admitted to the Department of Anesthesiology of Ningde People's Hospital were selected as research objects.They were divided into group A,group B,and group C by random number table method,with 50 patients in each group.Patients in group A were given 0.3 mg/kg Esmketamine,patients in group B were given 0.5 mg/kg Esmketamine,and patients in group C were given 1.0 mg/kg Esmketamine.Other anesthesia methods in the three groups were the same.Anesthesia related indexes,vital signs,postoperative pain score,cognitive function and adverse reactions in the three groups were observed.Results The time of onset of anesthesia,eye opening,orientation recovery and consciousness recovery in group B and C were shorter than those in group A,with statistically significant differences(P<0.05).The heart rate and mean arterial pressure of group B and C at the beginning,15 minutes and the end of the operation were higher than those of group A,with statistically significant differences(P<0.05).The pain scores of group B and C at 2,6,12 and 24 h after operation were lower than those of group A,with statistically significant differences(P<0.05).The scores of cognitive function in group B and C were higher than those in group A on the 1st and 2nd day after operation,with statistically significant differences(P<0.05).There were no significant difference between group B and group C in the time of onset of anesthesia,eye opening by exhalation,recovery of orientation,recovery of consciousness and heart rate,mean arterial pressure,pain score and cognitive function score at different time points(P>0.05).There was no significant difference in the total incidence of adverse reactions among the three groups(P>0.05).Conclusion Esketamine 0.5 mg/kg has been used for postoperative analgesia of elderly gastric cancer patients with satisfactory results,and the patient's vital signs are stable during operation,cognitive function damage is slight,and adverse reactions are few,which can be promoted and applied.