艾司氯胺酮对妇科腹腔镜术后疼痛及躁动的预防效果

Preventive effect of Esketamine on postoperative pain and agitation in patients undergoing gynecological laparoscopic surgery

目的观察艾司氯胺酮对妇科腹腔镜手术患者术后疼痛及躁动的预防价值。方法选取120例接受腹腔镜手术的治疗患者,按照随机数字表法将患者分为全麻组和联合组,每组60例。全麻组实施常规全身麻醉,联合组采用艾司氯胺酮辅助全身麻醉,比较两组患者的术后镇痛、镇静效果、手术应激情况、麻醉苏醒情况及麻醉安全性。结果术后,联合组P物质(SP)、前列腺素E2(PGE2)、神经生长因子(NGF)的水平均低于全麻组,差异具有统计学意义(P<0.05);术后1、3、5 h,联合组的Ramsay镇静评分(RSS)均高于全麻组(P<0.05);术后,联合组的去甲肾上腺素(NE)、皮质醇(Cor)、血管紧张素Ⅱ(AngⅡ)的水平均低于全麻组(P<0.05);联合组的睁眼时间、麻醉恢复室(PACU)停留时间与全麻组比较,差异均无统计学意义(P>0.05);联合组静脉自控镇痛泵(PCIA)应用时间、住院时间均短于全麻组(P<0.05)。两组与麻醉相关的不良反应发生率比较,无统计学差异(P>0.05)。结论艾司氯胺酮辅助全麻可增强妇科腹腔镜手术的镇痛、镇静效果,可在不影响麻醉苏醒情况或增加麻醉风险同时,有效避免术后疼痛与躁动。

Objective To observe the preventive value of Esketamine on postoperative pain and agitation in patients undergoing gynecological laparoscopic surgery.Methods 120 patients who underwent laparoscopic surgery were selected and were divide into the general anesthesia group and combination group using a random number table method,with 60 patients in each group.The patients in the general anesthesia group were received routine general anesthesia,while the patients in the combination group were received Esketamine assisted general anesthesia.The postoperative analgesic and sedative effects,surgical stress,anesthesia recovery,and anesthesia safety of patients were compared between the two groups.Results Under different anesthesia regimens,the postoperative levels of substance P(SP),prostaglandin E2(PGE2),and nerve growth factor(NGF)in the combination group were lower than those in the general anesthesia group,showing a statistically significant difference(P<0.05).The Ramsay sedation scores(RSS)at 1,3,and 5 after surgery in the combination group were higher than those in the general anesthesia group(P<0.05).The levels of norepinephrine(NE),cortisol(Cor),and angiotensin II(Ang II)in the combination group were lower than those in the general anesthesia group(P<0.05).There was no statistically significant difference(P>0.05)in the opening time and PACU stay time between the combination group and the general anesthesia group.The application time and hospitalization time of the patient-controlled intravenous analgesia pump(PCIA)in the combination group were lower than those in the general anesthesia group(P<0.05).There was no statistically significant difference in the incidence of anesthesia related side effects between the two groups of patients(P>0.05).Conclusion Esketamine assisted general anesthesia enhances the analgesic and sedative effects of gynecological laparoscopic surgery,effectively avoids postoperative pain and agitation without affecting anesthesia recovery or increasing anesthesia risk.