艾司氯胺酮联合右美托咪定对腹腔镜全子宫切除术患者术后早期认知功能的影响

Effect of esketamine combined with dexmedetomidine on early postoperative cognitive function in patients undergoing laparoscopic hysterectomy

目的:探讨艾司氯胺酮联合右美托咪定对腹腔镜全子宫切除术患者术后认知功能的影响。方法:选取2020年09月至2023年02月本院择期行腹腔镜全子宫切除术患者156例,随机将患者分为艾司氯胺酮联合右美托咪定组(A组)、艾司氯胺酮组(B组)和对照组(C组),每组52例。3组均采取全麻,麻醉诱导前,A组以右美托咪定0.3μg/kg和艾司氯胺酮0.5 mg/kg分别配生理盐水稀释到10 mL分开静脉泵注;B组以艾司氯胺酮0.5 mg/kg配生理盐水稀释到20 mL静脉泵注;C组以20 mL生理盐水静脉泵注,泵注时间均为10 min。比较3组术前及术后1、3、7 d的简易精神状态检查量表(mini-mental state examination,MMSE)评分;比较3组术后1、3、7 d术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生率;比较3组麻醉前(t_(1))、术毕(t_(2))、术后6 h(t_(3))及术后24 h(t_(4))血清炎性因子肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-6(interleukin-6,IL-6)和神经细胞因子神经元特异性烯醇化酶(neuron specific enolase,NSE)、S-100β水平;比较3组麻醉不良反应发生情况。结果:A、B组术后1、3、7 d MMSE评分高于C组,且A组高于B组(P<0.05);A、B组术后1、3、7 d POCD发生率低于C组,且A组低于B组(P<0.05);A、B组t_(2)、t_(3)、t_(4)时血清NSE、S-100β、TNF-α、IL-6水平低于C组,且A组低于B组(P<0.05);3组麻醉不良反应发生率组间比较差异无统计学意义(P>0.05)。结论:艾司氯胺酮联合右美托咪定用于腹腔镜全子宫切除术患者可减轻炎症反应和神经损伤,改善术后认知功能,减少POCD发生,安全性较好。

Objective:To explore the effect of esketamine combined with dexmedetomidine on early postoperative cognitive function in patients undergoing laparoscopic hysterectomy.Methods:From September 2020 to February 2023,156 patients with laparoscopic hysterectomy were selected.The patients were randomly divided into esketamine combined with dexmedetomidine group(group A),esketamine group(group B)and control group(group C),with 52 patients in each group.All the three groups were treated with general anesthesia.Before induction of anesthesia,group A was treated with dexmedetomidine 0.3μg/kg and 0.5 mg/kg of esketamine were diluted to 10 mL of normal saline and injected separately by intravenous pump,0.5 mg/kg of esketamine was diluted to 20 mL of normal saline in group B and 20 mL of normal saline was injected by intravenous pump in group C,and the injection time was 10 minutes.The scores of MMSE in the three groups were compared before surgery and on the 1 d,3 d,and 7 d after surgery.The incidence of postoperative cognitive dysfunction(POCD)in the three groups was compared on the 1 d,3 d,and 7 d after surgery.The serum inflammatory factors tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)and neurocytokines neuron specifice enolase(NSE)and S-100βin the three groups was compared before anesthesia(t_(1)),after surgery(t_(2)),6 hours after surgery(t_(3))and 24 hours after surgery(t_(4)).The adverse reactions of anesthesia in the three groups were compared.Results:The MMSE scores of group A and group B were higher than that of group C on the 1 d,3 d,and 7 d after surgery,and group A was higher than group B( P <0.05).The incidence of POCD in group A and group B was lower than that in group C on the 1 d,3 d,7 d after surgery,and group A was lower than group B( P <0.05).The level of serum NSE,S-100β,TNF-α and IL-6 of group A and group B was lower than those in group C at t_(2), t_(3), t_(4),and group A was lower than group B( P <0.05).There was no difference in the incidence of adverse reactions among the three groups( P >0.05). Conclusion: Esketamine combined with dexmedetomidine can reduce inflammatory reaction and nerve injury,improve postoperative cognitive function,reduce the occurrence of POCD and have good safety in patients undergoing laparoscopic hysterectomy.