亚麻醉剂量艾司氯胺酮联合TAPB对老年腹部手术患者神经认知功能的影响

Effect of Subanesthetic Dose of Esketamine Combined with TAPB on Neurocognitive Function in Elderly Patients Undergoing Abdominal Surgery

目的观察亚麻醉剂量艾司氯胺酮联合腹横肌平面阻滞(TAPB)用于改善老年腹部手术患者神经认知功能的临床效果。方法选取2023年1月-5月安徽医科大学附属巢湖医院接受择期行腹部手术的老年患者作为研究对象,按照随机数字表法分为S组和C组,每组46例。S组诱导前静脉注射0.25 mg/kg艾司氯胺酮,C组静脉注射等量生理盐水,之后两组均行TAPB,待麻醉平面稳定后进行麻醉诱导。术中S组以0.25 mg/(kg·h)艾司氯胺酮维持泵注,C组以0.25 mg/(kg·h)生理盐水维持泵注。比较两组各时间点MMSE评分、PND发生率、POD发生率、生命体征指标、不良反应发生率、VAS评分、Ramsay镇静评分、术中阿片类药物用量及TAP时体动反应发生率。结果S组D_(1)和D_(3)时点MMSE评分高于C组、PND发生率低于C组(P<0.05),且S组D_(1)时点POD发生率低于C组(P<0.05)。S组T_(1)和T_(2)时点MAP高于C组、T_(1)时期HR高于C组、T_(1)和T_(2)时点BIS值高于C组(P<0.05),而两组各个时点SpO2比较,差异无统计学意义(P>0.05)。两组术后72 h内恶心呕吐、烦躁和呼吸抑制发生率比较,差异无统计学意义(P>0.05)。S组术后6 h VAS评分低于C组(P<0.05),而两组术后各时间点Ramsay镇静评分比较,差异无统计学意义(P>0.05)。S组术中瑞芬太尼用量少于C组,TAPB时体动反应发生率低于C组(P<0.05),而两组舒芬太尼用量比较,差异无统计学意义(P>0.05)。结论对于老年腹部手术患者,亚麻醉剂量艾司氯胺酮联合TAPB可改善患者早期神经认知功能,维持术中生命体征稳定,减轻术后早期疼痛。

Objective To observe the clinical effect of subanesthetic dose of esketamine combined with transversus abdominis plane block(TAPB)on improving neurocognitive function in elderly patients undergoing abdominal surgery.Methods The elderly patients who underwent elective abdominal surgery in Chaohu Hospital Affiliated to Anhui Medical University from January to May 2023 were selected as the research objects.According to the random number table method,they were divided into group S and group C,with 46 patients in each group.In group S,0.25 mg/kg esketamine was injected intravenously before induction,while in group C,the same amount of normal saline was injected intravenously.After that,TAPB was performed in both groups,and anesthesia induction was performed after the anesthesia plane was stable.During the operation,group S was maintained with 0.25 mg/(kg·h)esketamine,and group C was maintained with 0.25 mg/(kg·h)normal saline.The MMSE score,incidence of PND,incidence of POD,vital signs,incidence of adverse reactions,VAS score,Ramsay sedation score,intraoperative opioid dosage and incidence of body movement reaction during TAP were compared between the two groups.Results The MMSE scores at D_(1)and D_(3)in group S were higher than those in group C,the incidence of PND was lower than that in group C(P<0.05),and the incidence of POD at D_(1)in group S was lower than that in group C(P<0.05).MAP at T_(1)and T_(2)in group S was higher than that in group C,HR at T_(1)was higher than that in group C,and BIS at T_(1)and T_(2)was higher than that in group C(P<0.05),but there was no significant difference in SpO2 between the two groups at each time point(P>0.05).There was no significant difference in the incidence of nausea and vomiting,irritability and respiratory depression between the two groups within 72 h after operation(P>0.05).The VAS score of group S was lower than that of group C at 6 h after operation(P<0.05),but there was no significant difference in Ramsay sedation score between the two groups at each time point after operation(P>0.05).The dosage of remifentanil in group S was less than that in group C,and the incidence of body movement reaction during TAPB was lower than that in group C(P<0.05),but there was no significant difference in the dosage of sufentanil between the two groups(P>0.05).Conclusion In elderly patients undergoing abdominal surgery,subanesthetic doses of esketamine combined with TAPB can improve early neurocognitive function,maintain stable intraoperative vital signs,and reduce early postoperative pain.