艾司氯胺酮对行ERCP的胆总管结石患者血流动力学及细胞免疫功能的影响

Effect of esketamine on hemodynamics and cellular immune function in patients with choledocholithiasis undergoing ERCP surgery

目的分析艾司氯胺酮对行经内镜逆行胰胆管造影术(ERCP)的胆总管结石患者血流动力学及细胞免疫功能的影响。方法前瞻性选择2021年5月至2023年5月太原钢铁(集团)有限公司总医院收治的80例胆总管结石患者为研究对象,按照随机数字表法分为观察组和对照组,各40例。对照组使用丙泊酚+阿芬太尼进行麻醉,观察组使用艾司氯胺酮+阿芬太尼进行麻醉。两组患者均由同一组医师行气管插管全身麻醉后开始ERCP治疗。比较两组的手术情况(手术时间、术中出血量、术中阿芬太尼用量、术后清醒时间及复苏室停留时间),结石完全清除率,麻醉前(T_(0))、进境时(T_(1))、括约肌置管时(T_(2))及手术结束清醒时(T_(3))的血流动力学指标[心率、平均动脉压(MAP)],比较两组的手术前后免疫功能(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、疼痛视觉模拟评分法(VAS)评分与健康状况调查简表(SF-36)评分及并发症发生率。结果两组手术时间、术中出血量、术中阿芬太尼用量及结石完全清除率比较,差异均无统计学意义(P>0.05),观察组术后清醒及复苏室停留时间分别为(8.97±2.14)、(19.97±4.61)min,均短于对照组[(12.33±3.52)、(23.33±5.28)min],差异均有统计学意义(P<0.05)。与T_(0)比较,两组T_(1)~T_(3)时心率、MAP均明显下降,差异均有统计学意义(P<0.05);T_(0)~T_(3)时,两组心率、MAP比较,差异均无统计学意义(P>0.05)。手术后,两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均较手术前下降,但观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)分别为(59.33±5.21)%、(45.31±9.12)%、1.65±0.32,均高于对照组[(56.43±5.19)%、(40.21±9.57)%、1.42±0.57],差异均有统计学意义(P<0.05)。手术后,两组VAS评分较手术前降低,SF-36评分较手术前升高,且观察组VAS评分为(2.34±0.72)分,低于对照组[(3.16±0.97)分],SF-36评分为(87.35±13.54)分,高于对照组[(80.57±11.61)分],差异均有统计学意义(P<0.05)。观察组并发症发生率为7.50%,低于对照组(25.00%),差异有统计学意义(P<0.05)。结论将艾司氯胺酮用于行ERCP的胆总管结石患者,可明显缩短其术后清醒时间,更利于维持患者血流动力学稳定,改善细胞免疫功能,减轻疼痛程度,提高生活质量,且并发症少,安全性较高,值得临床推广。

Objective To investigate the effect of esketamine on hemodynamics and cellular immune function in patients with choledocholithiasis undergoing endoscopic retrograde cholangiopancreatography(ERCP).Methods Eighty patients with choledocholithiasis admitted to General Hospital of Taiyuan Steel(Group)Co.,Ltd.from May 2021 to May 2023 were selected as the study objects,and were divided into observation group and control group according to the random number table method,with 40 cases in each group.The control group was anesthetized with propofol+afentanil,and the observation group was anesthetized with esketamine+afentanil.Two groups of patients were treated with ERCP after receiving general anesthesia through tracheal intubation by the same group of physicians.The surgical conditions(surgical time,intraoperative bleeding volume,intraoperative fentanyl dosage,postoperative waking time,and resuscitation room stay time),complete stone clearance rate,hemodynamic indexes[heart rate,mean arterial pressure(MAP)]before anesthesia(T_(0)),at entry(T_(1)),during sphincter intubation(T_(2)),and at the end of surgery when awake(T_(3))were compared between the two groups;the immune function(CD3^(+),CD4^(+),CD4^(+)/CD8^(+)),visual analogue scale(VSA)of pain,36-item Short-Form(SF-36)scores before and after surgery,and complication rates were compared between the two groups.Results There were no statistically significant differences between the two groups in terms of surgical time,intraoperative bleeding volume,intraoperative fentanyl dosage,and complete stone clearance rate(P>0.05),the postoperative waking time,and resuscitation room stay time in the observation group were(8.97±2.14)and(19.97±4.61)minutes,respectively,which were shorter than those in the control group[(12.33±3.52)and(23.33±5.28)minutes],and the differences were statistically significant(P<0.05).Compared with T 0,heart rate and MAP decreased significantly at T_(1)~T_(3),and the differences were statistically significant(P<0.05);there was no significant difference in heart rate and MAP between the two groups at T 0~T_(3)(P>0.05).After surgery,CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in two groups were lower than those before surgery,and CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in observation group were(59.33±5.21)%,(45.31±9.12)%,1.65±0.32,respectively,which were higher than those in control group[(56.43±5.19)%,(40.21±9.57)%,1.42±0.57],and the differences were statistically significant(P<0.05).After surgery,the VAS scores of the two groups were lower than those before surgery,while the SF-36 score were higher those before surgery,the VAS score of the observation group was(2.34±0.72)points,which was lower than that of the control group[(3.16±0.97)points],and the SF-36 score was(87.35±13.54)points,which was higher than that of the control group[(80.57±11.61)points],the differences were statistically significant(P<0.05).The complication rate of observation group was 7.50%,which was lower than that of control group(25.00%),the difference was statistically significant(P<0.05).Conclusion The use of esketamine in patients with choledocholithiasis undergoing ERCP can significantly shorten the postoperative waking time of patients,and is more conducive to maintaining the hemodynamic stability of patients,improving cellular immune function,alleviating pain and improving quality of life,with fewer complications and high safety,which is worthy of clinical promotion.