麻醉诱导中加入小剂量艾司氯胺酮对老年腹腔镜下无张力疝修补术血流动力学及术后认知功能的影响

Impact of Esketamine Adjunct to Anesthesia Induction on Hemodynamics and Postoperative Cognitive Function in Elderly Patients Undergoing Laparoscopic Tension-free Hernia Repair

目的:探讨麻醉诱导中加入小剂量艾司氯胺酮对老年腹腔镜下无张力疝修补术(TFH)患者血流动力学及术后认知功能的影响。方法:选取2024年1月至2024年6月九江学院附属医院收治的80例老年腹腔镜下TFH患者,按信封随机法分成Ⅰ组和Ⅱ组,各40例。Ⅰ组采用常规麻醉,Ⅱ组在常规麻醉基础上加用艾司氯胺酮,比较两组患者血流动力学和术后认知功能等指标。结果:麻醉前(T0)、麻醉诱导时(T1),Ⅰ组、Ⅱ组心率(HR)、平均动脉压(MAP)和脑电双频(BIS)值比较,差异无统计学意义(P>0.05);麻醉诱导后5 min(T2)、气管插管后5 min(T3)、BIS值<60(T4)时,Ⅱ组HR、MAP和BIS值高于I组,差异具有统计学意义(P<0.05);Ⅱ组T1 ~ T4时HR、MAP和BIS值和T0时比较,差异无统计学意义(P>0.05);Ⅰ组T1时HR、MAP、BIS值和T0时比较,差异无统计学意义(P>0.05),Ⅰ组T2 ~ T4时HR、MAP和BIS值低于T0时,差异具有统计学意义(P<0.05)。Ⅰ组、Ⅱ组在各时间点的经皮动脉血氧饱和度(SpO2)无差异,且组间差异无统计学意义(P>0.05)。Ⅰ组麻醉前、术后72 h时简易智能精神状态检查表(MMSE)得分比较,差异无统计学意义(P>0.05),I组术后6 h、24 h、48 h时MMSE得分低于麻醉前,且Ⅱ组术后6 h、24 h、48 h时MMSE得分高于Ⅰ组,差异具有统计学意义(P<0.05),Ⅱ组麻醉前和术后6 h、24 h、48 h、72 h时MMSE得分比较,差异无统计学意义(P>0.05)。结论:麻醉诱导中加入小剂量艾司氯胺酮的麻醉效果较好,有助于维持老年腹腔镜下TFH患者的血流动力学稳定,并能改善术后认知功能。

Objective This study aims to examine the effects of incorporating a small dose of esketamine into the anesthesia induction protocol on hemodynamic stability and postoperative cognitive function in elderly patients undergoing laparoscopic tension-free hernia repair(TFH).Methods A total of 80 elderly patients scheduled for laparoscopic TFH at the Jiujiang University Affiliated Hospital between January and June 2024 were randomly allocated into two groups(n=40 each)using a randomized envelope method.Group I received standard anesthesia,while GroupⅡreceived standard anesthesia plus esketamine.Hemodynamic parameters and postoperative cognitive function were assessed and compared between the groups.Results There were no significant differences in heart rate(HR),mean arterial pressure(MAP),and bispectral index(BIS)between Group I and GroupⅡat baseline(T0)and during anesthesia induction(T1)(P>0.05).At 5 minutes after anesthesia induction(T2),5 minutes after tracheal intubation(T3),and when BIS<60(T4),GroupⅡexhibited significantly higher HR,MAP,and BIS values compared to Group I(P<0.05).HR,MAP,and BIS values in GroupⅡremained stable from T1 to T4 when compared to T0(P>0.05).In contrast,Group I showed no significant changes at T1 relative to T0(P>0.05),but significant decreases in HR,MAP,and BIS values from T2 to T4 compared to T0 (P < 0.05). No significant differences in percutaneous arterial oxygen saturation (SpO2) were observed between groups at all time points (P > 0.05). Mini-Mental State Examination (MMSE) scores did not differ significantly before anesthesia and at 72 hours postoperatively within Group I (P > 0.05). MMSE scores at 6, 24, and 48 hours postoperatively were lower in Group I compared to pre-anesthesia, whereas Group Ⅱ had higher scores at these time points, with statistically significant differences (P < 0.05). MMSE scores in Group Ⅱ remained consistent from pre-anesthesia through 72 hours postoperatively (P > 0.05). Conclusion The administration of a small dose of esketamine during anesthesia induction in elderly patients undergoing laparoscopic TFH appears to enhance hemodynamic stability and improve postoperative cognitive function.