不同剂量艾司氯胺酮对腹腔镜全子宫切除术患者术后疼痛和情绪状态的影响

Effects of Different Doses of Esketamine on Postoperative Pain and Emotional State in Patients Undergoing Laparoscopic Total Hysterectomy

目的:探讨不同剂量艾司氯胺酮对腹腔镜全子宫切除术患者术后疼痛和情绪状态的影响。方法:按照随机数表法,选择2022年1月至2023年4月我院行腹腔镜全子宫切除术患者120例分为对照组(A组,n=40)、艾司氯胺酮0.25 mg/kg组(B组,n=40)、艾司氯胺酮0.5 mg/kg组(C组,n=40)。比较三组组围术期指标、术后1、4、8、24 h和48 h的疼痛评定数字量表(NRS)评分及术前1天(PRE1)、术后第1天(POD1)、术后第2天(POD2)的焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、血流动力学指标及不良反应。结果:B组和C组术后24 h舒芬太尼镇痛药物用量、补救镇痛例数小于A组,A组、B组苏醒时间、拔管时间短于C组(P<0.05)。B组、C组术后1 h的NRS评分低于A组(P<0.05),B组术后4 h、8 h、24 h的NRS评分低于A组,术后4 h、8 h的NRS评分低于C组(P<0.05)。与组内PRE1相比,三组POD1的SAS、SDS评分均升高(P<0.05)。B组、C组POD1、POD2的SAS、SDS评分均低于A组,且C组低于B组(P<0.05)。与组内PRE1相比,A组POD2的SAS、SDS评分升高(P<0.05)。与组内PRE1相比,B组POD2的SDS与C组POD2的SAS、SDS均降低(P<0.05)。在T3时刻,B组和C组的平均动脉压(MAP)、心率(HR)低于A组(P<0.05)。B组和C组术后恶心呕吐发生率低于A组(P<0.05);A组和B组术后头晕、苏醒延迟的发生率低于C组(P<0.05);三组术后苏醒期躁动和呼吸抑制的差异无统计学意义(P>0.05)。结论:0.25 mg/kg的艾司氯胺酮对减轻腹腔镜全子宫切除术患者术后疼痛,减少阿片类药物用量,改善负面情绪的临床效果更佳。

Objective:To investigate the effects of different doses of esketamine on postoperative pain and emotional state in patients undergoing laparoscopic total hysterectomy.Methods:According to the random number table method,120 patients who were undergoing laparoscopic total hysterectomy in our Hospital from January 2022 to April 2023 were selected,and divided into a control group(group A,n=40),esketamine 0.25 mg/kg group(group B,n=40)and esketamine 0.5 mg/kg group(group C,n=40).Perioperative indicators,The pain rating scale(NRS)scores at 1,4,8,24 h and 48 h after operation,the self-rating anxiety scale(SAS)scores and self-rating depression scale(SDS)scores at 1 day before operation(PRE1),1 day after operation(POD1)and 2 days after operation(POD2),hemodynamic indicators and adverse reactions were compared in three groups.Results:The dosage of sufentanil analgesics 24 h after surgery and the number of rescue analgesia cases in Group B and Group C were smaller than those in Group A,while the awakening time and extubation time in Group A and Group B were shorter than those in Group C(P<0.05).The NRS scores of Group B and Group C at 1 h after surgery were lower than those of Group A(P<0.05).The NRS scores of Group B at 4 h,8 h and 24 h after surgery were lower than those of Group A,and the NRS scores at 4 h,8 h after surgery were lower than those of Group C(P<0.05).Compared with the intra group PRE1,the SAS and SDS scores of POD1 in three groups increased(P<0.05).The SAS and SDS scores of POD1 and POD2 in group B and group C were lower than those in group A,and group C was lower than group B(P<0.05).Compared with the intra group PRE1,the SAS and SDS scores of POD2 in group A increased(P<0.05).Compared with the intra group PRE1,the SDS of group B POD2 and the SAS and SDS of group C POD2 were both reduced(P<0.05).At T3 moment,the mean arterial pressure(MAP)and heart rate(HR)of group B and group C were lower than those of group A(P<0.05).The incidence of postoperative nausea and vomitting in group B and group C were lower than that in group A(P<0.05).The incidence of postoperative dizziness and delaye of recovery in group A and group B were lower than that in group C(P<0.05).There was no statistically significant difference in resortification period restlessness and respiratory depression in three groups(P<0.05).Conclusion:The clinical effect of 0.25 mg/kg esketamine on reducing postoperative pain,reducing the dosage of opioids and improving negative emotions in patients undergoing laparoscopic total hysterectomy is better.