右美托咪定联合艾司氯胺酮麻醉对腹腔镜下全子宫切除术术后感染及炎症指标的影响

Effect of dexmedetomidine combined with esketamine anesthesia on postoperative infection and inflammatory indexes of patients undergoing laparoscopic total hysterectomy

目的探讨右美托咪定(DEX)联合艾司氯胺酮麻醉对腹腔镜下全子宫切除术患者术后感染及炎症指标的影响。方法选择2022年5月-2023年3月于温州市中心医院拟行腹腔镜下全子宫切除术的116例患者为研究对象,采用随机数字表法分为研究组和对照组各58例,两组分别在全麻过程中添加DEX、DEX+艾司氯胺酮。比较两组患者在麻醉诱导前(T0)、气管插管即刻(T1)、手术开始时(T2)、气管拔管即刻(T3)、拔管后10 min的平均动脉压(MAP)、心率(HR)、苏醒质量、炎症指标、术后感染及其他不良反应发生状况。结果研究组患者T1、T2、T3、T4的MAP、HR、自主呼吸的恢复时间、唤醒时间、拔除气管插管时间、镇静-躁动评分、术后感染的发生率均低于同期对照组(P<0.05)。与组内术前1 d的水平相比,两组患者术后1 d的血C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平升高(P<0.05),且研究组患者手术前后的血CRP、IL-6、TNF-α水平差值均低于对照组(P<0.05)。结论DEX联合艾司氯胺酮麻醉能明显提高腹腔镜下全子宫切除术患者术中血流动力学的稳定性,发挥较好的镇静、镇痛效果,同时能明显缓解术后炎症反应,降低感染风险。

OBJECTIVE To explore the effect of dexmedetomidine(DEX)combined with esketamine anesthesia on postoperative infection and inflammatory indexes of the patients undergoing laparoscopic total hysterectomy.METHODS A total of 116 patients who were scheduled to undergo laparoscopic total hysterectomy in Wenzhou Central Hospital from May 2022 to Mar.2023 were recruited as the research subjects and were randomly divided into the study group with 58 cases and the control group with 58 cases.The two groups were respectively added with DEX and DEX plus esketamine during the process of general anesthesia.The mean arterial pressure(MAP),heart rate(HR),awakening quality,inflammatory indexes and incidence of postoperative infection and other adverse reactions were observed and compared between the two groups of patients before anesthesia induction(T0),at immediate tracheal intubation(T1),at the beginning of surgery(T2),at immediate tracheal extubation(T3)and after the extubation for 10 min.RESULTS The MAP,HR,recovery time of spontaneous respiration,awakening time,time of removal of tracheal tubes,score of sedation agitation scale and incidence of postoperative infection were lower in the study group than in the control group at T1,T2,T3 and T4(P<0.05).The levels of serum C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)of the two groups of patients were higher after the surgery for 1 day than before the surgery for 1 day(P<0.05),and the difference values of serum CRP,IL-6 and TNF-αbefore and after the surgery were lower in the study group than in the control group(P<0.05).CONCLUSION DEX combined with esketamine anesthesia can remarkably improve the intraoperative hemodynamic stability of the patients undergoing laparoscopic total hysterectomy,show remarkable effect on sedation and analgesia,significantly alleviate postoperative inflammatory reactions,and reduce the risk of infection.