低剂量艾司氯胺酮对腹腔镜胆囊切除术麻醉效果和血清炎症因子的影响

Effects of low-dose esketamine on anesthesia and serum inflammatory factors in laparoscopic cholecystectomy

目的评价低剂量艾司氯胺酮对腹腔镜胆囊切除术(LC)的麻醉效果和血清炎症因子表达的影响。方法前瞻性选择2019年6月至2021年6月入海南医学院第二附属医院择期LC患者60例,随机分为对照组和观察组各30例,观察组诱导麻醉前给予艾司氯胺酮0.2mg/kg静脉注射,对照组应用等量生理盐水,均采用舒芬太尼+依托咪酯+顺阿曲库铵麻醉诱导方案,七氟醚+瑞芬太尼静吸复合麻醉维持方案。比较两组麻醉相关时间(手术时间、苏醒时间、拔管时间、定向力恢复时间);比较两组阿托品、去氧肾上腺素及麻醉药使用情况;比较两组术后镇痛和镇静评分;比较两组围术期炎症因子水平及不良反应。结果两组手术时间比较,差异无统计学意义(P>0.05);观察组苏醒时间、拔管时间和定向力恢复时间较对照组明显缩短(P<0.05)。两组术中去氧肾上腺素和阿托品使用率比较无差异(P>0.05);与对照组比较,观察组术中瑞芬太尼用量、术后舒芬太尼24h用量均减少,舒芬太尼首次使用时间延迟(P<0.05)。两组Ramsay评分在停药即刻、停药30、60min无明显差异(P>0.05);观察组停药5、10min时Ramsay评分低于对照组(P<0.05)。观察组术后1、6、12、24h静息与运动状态VAS评分均低于对照组(P<0.05)。观察组胆囊切除即刻、拔管后1h血清IL-6、TNF-α水平均低于对照组(P<0.05);两组胆囊切除即刻、拔管后1h血清IL-6、TNF-α水平均高于术前,且拔管后1h高于胆囊切除即刻(P<0.05)。两组麻醉不良反应发生率比较,差异无统计学意义(P>0.05)。结论低剂量艾司氯胺酮对LC患者有较好的麻醉效果,减少麻醉药及术后镇痛药用量,术后易唤醒、恢复快,炎症反应轻,镇痛镇静效果满意,安全性好。

Objective To evaluate the effect of low-dose esketamine on anesthesia and serum inflammatory factor expression in laparoscopic cholecystectomy(LC).Methods Sixty patients with elective LC into the Second Affiliated Hospital of Hainan Medical College from June 2019 to June 2021 were chosed in the prospective study.They were randomly divided into control group and observation group,with 30 patients in each group.The observation group was given esketamine 0.2mg/kg intravenously before induction of anesthesia,and the control group was given the same amount of normal saline.Both groups were treated with sufentanil+etomidate+cisatracurium anesthesia induction program,and sevoflurane+remifentanil intravenous inhalation compound anesthesia maintenance program.The anesthesia-related time(operation time,wake-up time,extubation time,and orientation recovery time)were compared between the two groups.Comparison of the use of atropine,phenylephrine and anesthetics between the two groups.Comparison of postoperative analgesia and sedation scores between the two groups.The perioperative inflammatory factor levels and adverse reactions were compared between the two groups.Results There was no significant difference in the operation time between the two groups(P>0.05).The recovery time,extubation time and orientation recovery time of the observation group were significantly shorter than those of the control group(P<0.05).There was no difference in the use rates of phenylephrine and atropine between the two groups(P>0.05).Compared with the control group,the dosage of remifentanil during operation and the dosage of sufentanil 24 hours after operation in the observation group were decreased,and the time of first use of sufentanil was delayed(P<0.05).There was no significant difference in Ramsay score between the two groups at the moment of drug withdrawal,30 and 60 minutes after drug withdrawal(P>0.05),while the Ramsay score in the observation group was lower than that in the control group at 5 and 10minutes after drug withdrawal(P<0.05).The VAS scores of resting and exercise states in the observation group were lower than those in the control group at 1,6,12,and 24 hours after operation(P<0.05).The levels of serum IL-6 and TNF-α in the observation group immediately after cholecystectomy and 1 hour after extubation were lower than those in the control group(P<0.05).The levels were higher than those before operation,and 1 hour after extubation was higher than that immediately after cholecystectomy(P<0.05).There was no significant difference in the incidence of adverse reactions of anesthesia between the two groups(P>0.05).Conclusion Low-dose esketamine has a good anesthetic effect on LC patients,reduces the dosage of anesthetics and postoperative analgesics,is easy to wake up after surgery,recovers quickly,has mild inflammatory reaction,and has satisfactory analgesic and sedative effects with good safety.