艾司氯胺酮对机器人辅助纵隔手术肠道功能的影响

Effect of esketamine on intestinal function in robot-assisted mediastinal surgery

目的 探讨艾司氯胺酮对机器人辅助纵隔手术肠道功能的影响。方法 选择2023年2-6月东部战区总医院择期行机器人辅助纵隔手术患者64例,年龄18~65岁,18.5 kg/m^(2)≤BMI<28 kg/m^(2),ASA I~III级。采用随机双盲设计法将患者分为2组:舒芬太尼组和艾司氯胺酮组,每组32例,分别静注舒芬太尼和艾司氯胺酮行全麻诱导,术后使用静脉自控镇痛(PCIA)。记录术后肠道通气时间和住院天数;诱导前、插管前、插管后3 min的动脉血压和心率;切皮前及气胸时低血压发生率;阿片类药物的使用总量;术前和术后第1天C-反应蛋白(CRP);术前和术后第1天、第2天、1个月的简易精神状态量表(MMSE)评分;术后6、12、24、48 h数字等级量表(NRS)评分和不良反应发生情况。结果 对照组和观察组术后肠道通气时间分别为(38.7±7.8) h、(27.8±4.3) h;住院天数分别为(1.85±0.37) d、(1.50±0.13) d,差异均有统计学意义(P<0.01)。与对照组比较,观察组插管前、插管后3 min的动脉血压和心率明显升高(P<0.01);对照组和观察组术中低血压发生率分别为53.3%、6.7%,差异有统计学意义(P<0.01)。对照组和观察组阿片类药物的使用总量分别为(188.65±24.45)mg、(127.08±22.40)mg,差异有统计学意义(P<0.01)。与对照组比较,观察组术后第1天CRP明显降低,差异有统计学意义(P<0.05)。2组不同时间点的MMSE评分、NRS评分和不良反应发生情况差异无统计学意义(P>0.05)。结论 艾司氯胺酮用于机器人辅助纵隔手术能够促进肠道功能恢复、缩短术后住院时间,可能与降低全麻诱导后低血压的发生率、阿片类药物的用量及炎症反应的程度有关。

Objective To investigate the effect of esketamine on intestinal function in robot-assisted mediastinal surgery.Methods A total of 64 patients,aged 18 to 65 years,18.5 kg/m^(2)≤BMI<28 kg/m^(2),ASA grade I to III,were selected to undergo robot-assisted mediastinal surgery in General Hospital of Eastern Theater Command from February to June 2023.Patients were divided into 2 groups by randomized double-blind design:Sufentanil group(control group)and esketamine group(observation group),32 ca-ses in each group.Sufentanil and esketamine were injected respectively to induce general anesthesia,and patient-controlled intravenous analgesia(PCIA)was used after surgery.The following data was recorded:postoperative intestinal ventilation time and hospital stay;arterial blood pressure and heart rate before induction,before intuba-tion and 3 min after intubation;incidence of hypotension before inci-sion and pneumothorax;total opioid use;C-reactive protein(CRP)before and on the first day after surgery;Mini-mental State Examina-tion(MMSE)scores were obtained before surgery and on the 1st,2nd and 1st month after surgery;Numerical Rating Scale(NRS)scores and adverse reactions at 6,12,24,48 h after surgery.Results The postoperative intestinal ventilation time of control group and observation group were(38.7±7.8)h and(27.8±4.3)h,respectively.The hospitalization days were(1.85±0.37)d and(1.50±0.13)d,respectively,with statistical significance(P<0.01).Compared with the control group,the arterial blood pressure and heart rate of the observation group were significantly increased before and 3 min after intubation(P<0.01).The incidence of intr-aoperative hypotension in control group and observation group was 53.3%and 6.7%,respectively,and the difference was statistically significant(P<0.01).The total use of opioids in control group and observation group was(188.65±24.45)mg and(127.08±22.40)mg,respectively,and the difference was statistically significant(P<0.01).Compared with the control group,CRP in the observation group was significantly decreased on the first day after surgery,and the difference was statistically significant(P<0.05).There were no significant differences in MMSE scores,NRS scores and adverse reactions between the two groups at different time points(P>0.05).Conclusion The use of esketamine in robot-assisted mediastinal surgery can promote the recovery of intestinal function and shorten the length of postoperative hospital stay,which may be related to the reduction of the incidence of hypotension after general an-esthesia,the dosage of opioids and the degree of inflammation.