小剂量艾司氯胺酮对腹腔镜直肠癌根治术患者导尿管膀胱刺激征的影响

Effect of low dose esketamine on urethral bladder irritation in patients undergoing laparoscopic radical resection of rectal cancer

目的 探讨腹腔镜直肠癌根治术中应用小剂量艾司氯胺酮的麻醉效果及其恢复期导尿管相关膀胱刺激征(catheter-related bladder discomfort,CRBD)的预防作用。方法 选取2020年1月至2023年9月于本院行腹腔镜直肠癌根治术的260例男性患者,均采用气管插管全身麻醉。采用简单排序随机化分为研究组和对照组,每组各130例。研究组于麻醉诱导后,导尿管插入前给予0.2 mg/kg艾司氯胺酮,对照组给予等剂量0.9%氯化钠注射液,两组麻醉诱导及维持方案相同。观察两组气管拔管即刻(T0)、拔管后10 min(T1)、30 min(T2)、1 h(T3)及4 h(T4)的CRBD发生率,统计拔管4 h内两组CRBD总发生率及严重程度;观察各时间段的血流动力学指标、Ramsay镇静评分和疼痛视觉模拟评分法(visual analogue scale,VAS)评分;比较术后并发症及不良反应发生情况。结果 T0、T1时,研究组CRBD发生率显著低于对照组(P<0.05);研究组CRBD总发生率低于对照组(43.08% vs 64.42%,P<0.05);研究组中、重度CRBD发生率低于对照组(19.2% vs 46.9%,P<0.05)。与T0比较,两组T2~T4时的心率、平均动脉压水平均明显降低(P<0.05);与对照组比较,研究组T1~T4时的Ramsay镇静评分较高,T3~T4时疼痛VAS评分较低(P<0.05);与T0比较,两组T1~T2时Ramsay镇静评分逐渐升高(P<0.05),T3~T4时Ramsay镇静评分逐渐降低,而疼痛VAS评分逐渐升高(P<0.05)。两组并发症及不良反应比较,差异无统计学意义(P>0.05)。结论 给予小剂量艾司氯胺酮能有效降低腹腔镜直肠癌根治术患者麻醉恢复期CRBD的发生率,并减轻其严重程度,具有良好的镇痛、镇静效果,且不增加并发症的发生风险。

Objective To investigate the anesthetic effects of low-dose esketamine in laparoscopic radical resection of rectal cancer and the preventive effects of catheter-related bladder discomfort(CRBD)during convalescence.Methods A total of 260 male patients who underwent laparoscopic radical resection for rectal cancer from January 2020 to September 2023 were selected,all of whom underwent general anesthesia with tracheal intubation.The patients were divided into study group and control group by simple randomization,with 130 cases in each group.After anesthesia induction,the study group was given 0.2mg/kg esketamine before catheter insertion,while the control group was given 0.9%sodium chloride injection at the same dose,the induction and maintenance of anesthesia were the same in both groups.The incidence and severity of CRBD immediately after trachea extubation(T0),10 min(T1),30 min(T2),1 h(T3)and 4 h(T4) were observed in both groups, and the total incidence and severity of CRBD in the two groups within 4 h of extubation were analyzed. The hemodynamic indexes, Ramsay sedation score and visual analogue scale(VAS) pain score were observed at each time period. Postoperative complications and adverse reactions were compared between the two groups. Results At T0 and T1, the incidence of CRBD in study group was signiffcantly lower than that in control group(P<0.05). The total incidence of CRBD in the study group was signiffcantly lower than that in the control group (43.08% vs 64.62%, P<0.05). The incidence of moderate to severe CRBD in the study group was lower than that in the control group(19.2% vs 46.9%,P<0.05). Compared with T0, the heart rate and mean arterial pressure of T2—T4 in both groups were signiffcantly decreased(P<0.05). Compared with the control group, the Ramsay sedation score at T1—T4 were higher in the study group, and the VAS pain score at T3—T4 were lower(P<0.05). Compared with T0, T1—T2 Ramsay sedation score were gradually increased(P<0.05), T3—T4 Ramsay sedation score were gradually decreased, and VAS pain score were gradually increased in both groups(P<0.05). There was no signiffcant difference in complications and adverse reactions between the two groups(P>0.05). Conclusion Low-dose esketamine can effectively reduce the incidence and severity of CRBD in patients undergoing laparoscopic radical resection of rectal cancer during anesthesia recovery, with good analgesic and sedative effects, without increasing the risk of complications.