艾司氯胺酮复合丙泊酚麻醉对腹腔镜胆囊切除术患者术后疼痛和血清炎症指标的影响

Effect of Anesthesia with Esketamine and Propofol on Postoperative Pain and Serum Inflammatory Markers in Patients Undergoing Laparoscopic Cholecystectomy

目的:探讨艾司氯胺酮复合丙泊酚麻醉对腹腔镜胆囊切除术(LC)患者术后疼痛和炎症指标的影响。方法:选取2021年12月至2023年12月我院拟行LC患者84例,随机数字表法分成对照组与观察组,各42例,两组分别采用丙泊酚+舒芬太尼、丙泊酚+艾司氯胺酮进行麻醉诱导。观察两组围术期相关指标,分析两组入室时(T0)、麻醉诱导后(T1)、手术开始10 min(T2)、术毕(T3)及清醒时(T4)Ramsay镇静评分,评估两组术后1、6、12、24 h视觉疼痛模拟量表(VAS)得分,比较两组术前、术后24 h应激反应指标;比较两组术前、术后1 d、术后3 d炎症指标变化,统计两组不良反应发生率。结果:观察组苏醒时间、复苏室停留时间均短于对照组,丙泊酚输注总量少于对照组(P<0.05)。观察组T1、T2 Ramsay镇静评分高于对照组,T3 Ramsay镇静评分低于对照组(P<0.05)。观察组各时间点VAS得分均低于对照组(P<0.05)。观察组术后1dCor、NE、Glu水平均低于对照组(P<0.05)。观察组术后1、3 d C反应蛋白、白介素-6水平均低于对照组(P<0.05)。两组不良反应发生率无明显差异(P>0.05)。结论:对LC患者予以艾司氯胺酮复合丙泊酚麻醉镇静效果较好,能减少麻醉药物用量,促进术后苏醒,抑制炎症及应激反应,减轻术后疼痛。

Objective:To investigate the effect of anesthesia with esketamine and propofol on postoperative pain and inflammatory markers in patients undergoing laparoscopic cholecystectomy(LC).Methods:Eighty-four patients who were scheduled to undergo LC in the hospital from December 2021 to December 2023 were selected,and divided into a control group and an observation group using the random number table method,with 42 cases in each group.The two groups were given anesthesia induction with propofol and sufentanil,and anesthesia induction with propofol and esketamine,respectively.Perioperative related indicators in the two groups were observed.Ramsay sedation scores of the two groups when the patients entered the room(T0),after anesthesia induction(T1),at 10 min after the beginning of surgery(T2),at the end of surgery(T3),and when they were awake(T4)were analyzed.The Visual Analogue Scale(VAS)scores of the two groups at 1 h,6 h,12 h and 24 h after surgery were evaluated.Stress response indicators before surgery and at 24 h after surgery,and changes in inflammatory markers before surgery and on day 1 and day 3 after surgery were compared between the two groups.The incidence rates of adverse reactions in the two groups were calculated.Results:Comparison between the observation group and the control group found that wake-up time and PACU stay of the former group were shorter.The total dosage of propofol in the former group was lower(P<0.05).At T1 and T2,Ramsay sedation scores of the former group were higher.At T3,Ramsay sedation score of the former group was lower(P<0.05).The levels of Cor,NE,and Glu in the former group were lower on day 1 after surgery(P<0.05).The levels of CRP and IL-6 in the former group were lower on day 1 and day 3 after surgery(P<0.05).The incidence rates of adverse reactions showed no significant difference between groups(P>0.05).Conclusion:Anesthesia with esketamine and propofol can achieve good sedative effect on patients undergoing LC,which can reduce the dosage of anesthetics,promote postoperative recovery,inhibit inflammation and stress reaction,and alleviate postoperative pain.