腹腔镜子宫肌瘤手术中低剂量艾司氯胺酮的麻醉效果

Anesthesia effect of low-dose esketamine used in laparoscopic uterine fibroid surgery

目的:分析低剂量艾司氯胺酮在腹腔镜子宫肌瘤手术中的麻醉效果。方法:按随机数字表法将2022年1月-2023年12月本院拟行腹腔镜下行子宫肌瘤手术患者102例分为观察组和对照组各51例。两组麻醉诱导和维持方法相同,观察组在切皮前静脉注射艾司氯胺酮0.5mg/kg,随后持续静脉泵注艾司氯胺酮0.125mg/kg/h,对照组给予等量0.9%氯化钠注射液。观察记录两组麻醉、手术、术后苏醒、拔管等时长,不同时点VAS疼痛评分、Ramsay镇静评分、应激反应(肾上腺素、去甲肾上腺素、皮质醇)及术后不良反应发生情况。结果:术后6h、12h,观察组VAS评分(2.01±0.22分、2.33±0.36分)均低于对照组(3.25±0.28分、3.62±0.47分);术后24h肾上腺素、去甲肾上腺素、皮质醇水平两组均较术前升高但观察组(69.62±8.54 pg/ml、175.60±24.79 pg/ml、290.92±27.19 ng/ml)低于对照组(85.52±7.63 pg/ml、198.96±23.29 pg/ml、320.25±28.74 ng/ml)(均P<0.05);两组不良反应总发生(19.6%、29.4%)无差异(P>0.05)。结论:低剂量艾司氯胺酮能增强患者术后镇痛效果,减轻术后应激反应,不增加麻醉相关不良反应,具有一定的安全性和有效性。

Objective:To analyze the anesthesia effect of low-dose esketamine used in laparoscopic uterine fibroid surgery.Methods:102 patients who wanted laparoscopic uterine fibroids surgery were divided into study group(n=51)and control group(n=51) using a random number table method from January 2022 to December 2023.The anesthesia induction and maintenance methods of the patients in both groups were the same.The patients in the study group received intravenous injection esketamine(0.5mg/kg) before skin incision,followed by continuous intravenous infusion of 0.125mg/(kg·h) of esketamine.The patients in the control group received an equal amount of 0.9% sodium chloride injection at the same time.The anesthesia time-the surgical time-the postoperative recovery time-the extubation time-the VAS pain score at different time points-the Ramsay sedation score-the levels of stress response-such as adrenaline,norepinephrine and cortisol,and the incidence of postoperative adverse reactions of the patients in the two groups were observed and recorded.Results;The VAS scores of the patients in the study group at 6h and 12h after operation(2.01±0.22 points and 2.33±0.36 points) were significantly lower than those(3.25±0.28 points and 3.62±0.47 points) of the patients in the control group.The levels of epinephrine,norepinephrine and cortisol of the patients in the two groups at 24h after operation had increased significantly,but which(69.62±8.54 pg/ml,198.96±23.29 pg/ml and 290.92±27.19 ng/ml) of the patients in the study group were significantly lower than those(85.52±7.63 pg/ml,175.60±24.79 pg/ml and 320.25±28.74ng/ml) of the patients in the control group(all P<0.05).There was no significant difference in the total incidence of adverse reactions(19.6% vs.29.4%)of the patients between the two groups(P>0.05).Conclusion:Low dose esketamine can enhance the postoperative analgesic effect,reduce the postoperative stress reactions and do not increase anesthesia related adverse reactions of the patients,which has certain safety and effectiveness.