艾司氯胺酮诱导对老年腹腔镜患者术后认知功能的影响

Effects of Esketamine Induction on Postoperative Cognitive Function in Elderly Patients Undergoing Laparoscopy

目的 探讨艾司氯胺酮诱导对老年腹腔镜患者术后认知功能的影响。方法 随机选择2020年9月—2021年9月期间广州医科大学附属第四医院肝胆外科60例拟行腹腔镜胆囊切除术患者,采用随机数表法分成研究组和对照组,每组30例。研究组静脉注射艾司氯胺酮行全身麻醉诱导;对照组静脉注射舒芬太尼行全身麻醉诱导。比较两组患者的血流动力学、认知变化、围术期指标和不良反应情况。结果 研究组在T3(手术结束时)的平均动脉压(75.16±3.54)mmHg、心率(85.34±6.51)次/min较对照组(86.26±2.53)mmHg、(92.35±7.35)次/min低,差异有统计学意义(t=13.970、3.911,P<0.05)。研究组术后24 h的MoCA评分(21.91±1.83)分高于对照组,差异有统计学意义(t=11.740,P<0.05)。研究组麻醉时间(101.12±10.79)min和意识恢复时间(9.46±1.96)min少于对照组,差异有统计学意义(t=3.002、3.945,P<0.05)。两组患者麻醉相关不良反应对比,差异无统计学意义(χ^(2)=0.000,P=1.000)。结论 艾司氯胺酮麻醉诱导有利于缩短麻醉时间,促进老年手术患者意识恢复,并且可减轻认知功能损伤,不会明显增加不良反应的发生。

Objective To investigate the effect of esketamine induction on postoperative cognitive function in elderly patients undergoing laparoscopy.Methods From September 2020 to September 2021,60 patients who were scheduled to undergo laparoscopic cholecystectomy in the Department of Hepatobiliary Surgery of the Fourth Affiliated Hospital of Guangzhou Medical University were randomly selected.They were divided into study group and control group by random number table method,with 30 cases in each group.The study group received general anesthesia induction with intravenous injection of esketamine;the control group received intravenous injection of sufentanil for induction of general anesthesia.The hemodynamics,cognitive changes,perioperative indicators and adverse reactions were compared between the two groups.Results The average arterial pressure(75.16±3.54)mmHg and heart rate(85.34±6.51)beats/min in the study group at T3(at the end of the operation)were lower than those in the control group(86.26±2.53)mmHg and(92.35±7.35)beats/min,the difference was statistically significant(t=13.970,3.911,P<0.05).The MoCA score of the study group 24 hours after operation(21.91±1.83)points was higher than that of the control group,and the difference was statistically significant(t=11.740,P<0.05).The anesthesia time(101.12±10.79)min and consciousness recovery time(9.46±1.96)min in the study group were shorter than those in the control group,and the difference was statistically significant(t=3.002,3.945,P<0.05).There was no statistically significant difference in anesthesia-related adverse reactions between the two groups(χ^(2)=0.000,P=1.000).Conclusion Esketamine anesthesia induction is beneficial to shorten the anesthesia time,promote the recovery of consciousness in elderly patients undergoing surgery,and reduce cognitive impairment without significantly increasing the occurrence of adverse reactions.