预防性应用艾司氯胺酮对腹腔镜胆囊切除术患者术后寒战的影响

Effect of Prophylactic Use of Esketamine on Postoperative Chills in Patients Undergoing Laparoscopic Cholecystectomy

目的分析预防性应用艾司氯胺酮对腹腔镜胆囊切除术患者术后寒战的影响。方法选取2022年3月至2023年4月山东省立第三医院收治的行腹腔镜胆囊切除术并预防性应用艾司氯胺酮治疗的60例患者作为观察组,另选取60例该院同期行腹腔镜胆囊切除术并于手术结束前静脉注射0.9%氯化钠溶液的患者作为对照组。比较两组患者术中及术后一般情况,拔管前后Ramsay镇静评分(RSS评分)、视觉模拟评分法(VAS)评分,寒战发生情况,术中和术后血流动力学指标[心率、呼吸频率(RR)、脉搏血氧饱和度(SpO_(2))、平均动脉压(MAP)],以及术后不良反应发生情况。结果两组患者手术时间、术中补液量、麻醉时间、苏醒时间及定向力恢复时间比较差异无统计学意义(P>0.05)。拔管前后RSS评分、VAS评分的主效应差异有统计学意义(P<0.01),不考虑测量时间,RSS评分、VAS评分组间的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.05)。两组患者拔管后10 min、30 min的RSS、VAS评分均低于拔管前(P<0.05),但观察组拔管后10 min、30 min的RSS评分高于对照组,VAS评分低于对照组(P<0.05)。观察组寒战发生率明显低于对照组[6.67%(4/60)比25.00%(15/60)](χ^(2)=7.566,P=0.006)。观察组术中与术后心率、RR、MAP均明显低于对照组(P<0.05或P<0.01),两组的SpO_(2)比较差异无统计学意义(P>0.05)。两组患者术后不良反应发生率比较差异无统计学意义(P>0.05)。结论预防性应用艾司氯胺酮具有较好的镇静及镇痛作用,可有效预防腹腔镜胆囊切除术后寒战的发生,稳定患者血流动力学指标,且不会增加术后不良反应的发生。

Objective To analyze the effect of prophylactic esketamine on postoperative chills in patients undergoing laparoscopic cholecystectomy.Methods A total of 60 patients who received laparoscopic cholecystectomy and prophylactic esketamine treatment in Shandong Provincial Third Hospital from Mar.2022 to Apr.2023 were included as an observation group,and 60 patients who underwent laparoscopic cholecystectomy and were injected with normal saline(0.9%sodium chloride solution)intravenously before the end of the operation during the same period were included as a control group.The intraoperative and postoperative general data,Ramsay sedation score(RSS score)and visual analog scale(VAS)score before and after extubation,incidence of chills,intraoperative and postoperative hemodynamic indexes[heart rate,respiratory rate(RR),pulse oxygen saturation(SpO_(2)),mean arterial pressure(MAP)],and postoperative adverse reactions were compared between the two groups.Results There were no significant differences in operation time,intraoperative fluid volume,anesthesia time,recovery time and orientation recovery time between the two groups(P>0.05).The differences in RSS score and VAS score before and after extubation were statistically significant(P<0.01);regardless of the measurement time,the differences of RSS score and VAS score between groups were statistically significant(P<0.01),and there were interactions between groups and time points(P<0.05).The RSS and VAS scores at 10 min and 30 min of both groups were lower than those before extubation(P<0.05),but the RSS scores at 10 min and 30 min after extubation of the observation group were higher than those of the control group,and the VAS scores was lower than the control group(P<0.05).The incidence of chills in the observation group were significantly lower than those in the control group[6.67%(4/60)vs 25.00%(15/60)](χ^(2)=7.566,P=0.006).The intraoperative and postoperative levels of heart rate,RR and MAP in the observation group were significantly lower than those in the control group(P<0.05 or P<0.01),and there was no significant difference in SpO_(2) between the two groups(P>0.05).There was no significant difference in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion Prophylactic use of esketamine has good sedative and analgesic effects,which can effectively prevent the occurrence of chills after laparoscopic cholecystectomy,stabilize the hemodynamic indexes of patients,and do not increase postoperative adverse reactions.