艾司氯胺酮复合丙泊酚对无痛胃肠镜检查患者术后疲劳的影响

Impact of esketamine combined with propofol on postoperative fatigue in patients undergoing pain-free gastrointestinal endoscopy

目的探讨艾司氯胺酮复合丙泊酚对无痛胃肠镜检查术患者术后疲劳(postoperative fatigue,POF)的影响。方法招募2023年5月至2024年4月于河南省人民医院择期行无痛胃肠镜检查术的患者476例,随机分成研究组和对照组,每组238例。对照组静脉注射芬太尼1μg/kg和丙泊酚1.5 mg/kg。观察组静脉注射艾司氯胺酮0.5 mg/kg和丙泊酚1.5 mg/kg。主要指标为术前1 d、术后1、3、7 d的疲劳程度评估量表(FSS)评分。次要指标为手术时间、苏醒时间、独立行走时间和麻醉后监护室(PACU)入住时长;麻醉期间并发症的发生率以及术后2天内的不良事件如恶心呕吐、呼吸抑制、头晕、嗜睡、高血压、低血压、窦性心动过速和窦性心动过缓等的发生情况;检查后胃肠道反应的发生率以及该检查的医生和患者满意度视觉模拟量表(VAS)评分。结果与术前1 d相比,两组在术后1、3、7 d时FSS评分均有显著升高(P<0.05);与对照组相比,研究组在术后1、3、7 d时FSS评分均显著降低(P<0.05)。术后7 d内,对照组共有71例(29.8%)患者发生POF,研究组共有35例(14.7%)患者发生POF,研究组POF发生率低于对照组(P<0.05)。研究组患者的苏醒时间、独立行走时间和PACU入住时长明显快于对照组(P<0.05)。研究组无痛胃镜检查中常见并发症如低氧血症、低血压和打嗝的发生率显著低于对照组(P<0.05)。检查后,研究组恶心、呕吐、腹胀和腹痛的发生率显著低于对照组(P<0.05)。检查医生和患者对本次无痛胃镜检查均满意,两组VAS评分无显著差异(P>0.05),但研究组操作人员的VAS评分仍较高。结论艾司氯胺酮复合丙泊酚可降低无痛胃肠镜检查术患者POF,加快术后恢复,降低术中及术后不良事件的发生率。

Objective To investigate the influence of esketamine combined with propofol on postoperative fatigue(POF)in patients undergoing pain-free gastrointestinal endoscopy.Methods A total of 476 patients scheduled for elective painless gastrointestinal endoscopy were recruited and randomly divided into a trial group and a control group,with 238 patients in each group.In the control group,intravenous injection of fentanyl 1μg/kg and propofol 1.5 mg/kg were administered.In the trial group,intravenous injection of etomidate 0.5 mg/kg and propofol 1.5 mg/kg were administered.The primary outcome was the assessment of fatigue using the Fatigue Severity Scale(FSS)on the day before surgery,and 1,3,and 7 days after surgery.Secondary outcomes included the duration of surgery,time to awakening,time to independent walking,and length of stay of post-anesthesia care unit(PACU);The incidence of complications during anesthesia,and adverse events such as nausea and vomiting,respiratory depression,dizziness,drowsiness,hypertension,hypotension,sinus tachycardia and sinus bradycardia occurred within 2 days after surgery;the incidence of gastrointestinal reactions after the examination,and the Visual Analog Scale(VAS)scores of physician and patient satisfaction with the examination.Results Compared to the day before surgery,FSS scores in both groups increased on postoperative days 1,3,and 7(P<0.05);Compared to the control group,FSS scores in the trial group decreased on postoperative days 1,3,and 7(P<0.05).Within 7 days after surgery,71 patients(29.8%)in trial group developed POF,and 35 patients(14.7%)in control group developed POF.The incidence of POF in control group was lower than that in trial group(P<0.05).Patients in control group had significantly shorter awakening,independent walking time and length of stay of PACU than those in trial group(P<0.05).The incidence of common complications during pain-free gastrointestinal endoscopy,such as hypoxemia,hypotension,and hiccups,was significantly lower in control group than those in trial group(P<0.05).After the examination,the incidence of nausea,vomiting,bloating,and abdominal pain was significantly lower in control group than those in trial group(P<0.05).Both the examining physicians and patients were satisfied with the pain-free gastrointestinal endoscopy,with no significant difference in VAS scores between the two groups(P>0.05),but the VAS score of the operating personnel in control group was still higher.Conclusion Esketamine combined with propofol can reduce POF in patients undergoing pain-free gastrointestinal endoscopy,accelerate postoperative recovery,and reduce the incidence of intraoperative and postoperative adverse events.