不同剂量艾司氯胺酮复合丙泊酚应用于腹腔镜下结直肠癌根治术老年患者效果及对苏醒质量的影响

Effect of Different Doses of Esketamine Combined with Propofol on Elderly Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer and Its Influence on the Quality of Awakening

目的:比较不同剂量艾司氯胺酮复合丙泊酚对腹腔镜下结直肠癌根治术老年患者的麻醉效果及对苏醒质量的影响,探究艾司氯胺酮最佳使用剂量。方法:选择2023年2月—2024年4月于赣南医科大学第一附属医院行择期全麻下腹腔镜结直肠癌根治术的老年患者120例,随机分为四组,每组30例。低剂量组给予艾司氯胺酮0.1 mg/kg,中剂量组给予艾司氯胺酮0.3 mg/kg,高剂量组给予艾司氯胺酮0.5 mg/kg,对照组给予10 mL生理盐水。记录四组不同时间点的平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR),并记录四组手术时间、出血量、输液量、尿量、维持麻醉用药量、术后苏醒相关指标及并发症发生情况。结果:四组不同时间点MAP、HR比较,差异均无统计学意义(P>0.05)。四组手术时间、出血量、输液量、尿量比较,差异均无统计学意义(P>0.05);与对照组比较,高剂量组丙泊酚、瑞芬太尼用量均低,差异均有统计学意义(P<0.05)。与对照组比较,中剂量组与高剂量组术后睁眼时间、拔管时间均短,差异均有统计学意义(P<0.05);四组麻醉恢复室(PACU)停留时间比较,差异无统计学意义(P>0.05);与对照组、低剂量组比较,高剂量组拔管后视觉模拟评分法(VAS)评分均低,差异均有统计学意义(P<0.05)。四组不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:0.3 mg/kg艾司氯胺酮应用于腹腔镜结直肠癌根治术老年患者中,术后苏醒较为迅速,但0.5 mg/kg的剂量,镇痛效果更好,并可减少术中丙泊酚、瑞芬太尼用量。

Objective:To compare the anesthetic effect of different doses of Esketamine combined with Propofol on elderly patients undergoing laparoscopic radical resection of colorectal cancer and its influence on the quality of awakening,and to explore the optimal dosage of Esketamine.Method:A total of 120 elderly patients who underwent selective laparoscopic radical resection of colorectal cancer under general anesthesia in First Affiliated Hospital of Gannan Medical University from February 2023 to April 2024 were selected and randomly divided into four groups,with 30 cases in each group.The low-dose group was given Esketamine 0.1 mg/kg,the mediumdose group was given Esketamine 0.3 mg/kg,the high-dose group was given Esketamine 0.5 mg/kg,and the control group was given 10 mL normal saline.The mean arterial pressure(MAP)and heart rate(HR)of the four groups were recorded at different time points,and operative time,blood loss,infusion volume,urine volume,maintenance anesthesia dosage,postoperative recovery related indexes and complications of the four groups were recorded.Result:There were no significant differences in MAP and HR among the four groups at different time points(P>0.05).There were no significant differences in operative time,blood loss,infusion volume and urine volume among the four groups(P>0.05).Compared with control group,the dosage of Propofol and Remifentanil in high-dose group were lower,the differences were statistically significant(P<0.05).Compared with the control group,the postoperative eye opening time and extubation time in the medium-dose group and high-dose group were shorter,the differences were statistically significant(P<0.05).There was no significant difference in postanesthesia care unit(PACU)residence time among the four groups(P>0.05).Compared with the control group and the low-dose group,the visual analogue scale(VAS)score after extubation in the high-dose group was lower,the differences were statistically significant(P<0.05).There were no significant differences in the incidences of adverse reactions among the four groups(P>0.05).Conclusion:The application of 0.3 mg/kg Esketamine in elderly patients undergoing laparoscopic radical resection of colorectal cancer has a faster postoperative recovery,but the dosage of 0.5 mg/kg has a better analgesic effect and can reduce the dosage of Propofol and Remifentanil during operation.