摘要
目的 探究艾司氯胺酮联合丙泊酚全麻诱导对接受腹腔镜胆囊手术的老年患者血清磷脂酰肌醇-3-羟基酶(P13K)/丝氨酸-苏氨酸蛋白激酶(AKT)信号通路的影响.方法 前瞻性选取2021年1月至2023年12月在安徽省公共卫生临床中心行腹腔镜胆囊手术的80例老年患者为研究对象,按照随机数字表法分为对照组和研究组,每组各40例.对照组实施丙泊酚全麻诱导方案,研究组在对照组麻醉方案中加用艾司氯胺酮.比较两组患者的临床指标(苏醒时间、拔管时间及定向力恢复时间),麻醉诱导前5 min(T0)、诱导完成(T,)、插管(T2)、拔管(T3)患者的心率及平均动脉压,术后30 min、术后2 h、6 h、12 h、24 h的Ramsay评分,术后30 min、2 h、6 h、12 h、24 h时的视觉模拟评分法(VAS)评分,以及术前、术后即刻、术后1 d及术后3 d时的PI3K、AKT水平,并观察两组患者的不良反应发生情况.结果 研究组患者的苏醒时间、拔管时间及定向力恢复时间均短于对照组,差异均有统计学意义(P＜0.05).T0时,两组间平均动脉压、心率比较,差异均无统计意义(P＞0.05);研究组T1时平均动脉压、心率均高于对照组,T2、T3时平均动脉压、心率均低于对照组,差异均有统计学意义(P＜0.05).术后30 min和术后2 h时,研究组Ramsay评分高于对照组,差异均有统计学意义(P＜0.05);但在术后6、12、24 h时的Ramsay评分比较,差异均无统计学意义(P＞0.05).术后30 min、2 h、6 h、12 h、24 h时,研究组患者的VAS评分均低于对照组,差异均有统计学意义(P＜0.05).术后即刻、术后1 d及术后3 d时,研究组血清PI3K、AKT水平均低于对照组,差异均有统计学意义(P＜0.05).两组总不良反应发生率比较,差异无统计学意义(P＞0.05).结论 艾司氯胺酮联合丙泊酚全麻诱导在腹腔镜胆囊手术中的应用对老年患者的生命体征、麻醉恢复过程和术后疼痛控制均有积极影响,其对疼痛的控制与调节PI3K/AKT信号通路有关,可为临床麻醉管理提供潜在的有效策略.
Abstract
Objective To explore the effect of esketamine combined with propofol on serum phosphatidylinositol-3-hydroxyase(PI3K)/serine-threonine protein kinase(AKT)signaling pathway in elderly patients undergoing laparoscopic gallbladder surgery.Methods A total of 80 elderly patients who underwent laparoscopic cholecystectomy in Anhui Public Health Clinical Center from January 2021 to December 2023 were prospectively selected as the research objects.According to the random number table method,they were divided into the control group and the study group,with 40 cases in each group.The control group received propofol general anesthesia induction,the study group received es-ketamine and propofol general anesthesia induction.The clinical indexes(recovery time,extubation time and orientation recovery time),heart rate and mean arterial pressure of patients at 5 min before anesthesia induction(T0),induction completion(T1),intubation(T2)and extubation(T3),Ramsay scores at 30 min,2 h,6 h,12 h and 24 h after operation,visual analogue scale(VAS)scores at 30 min,2 h,6 h,12 h and 24 h after operation,and PI3 K and AKT levels before operation,immediately after operation,1 d and 3 d after operation were compared between the two groups.The adverse reactions of the two groups were observed.Results The recovery time,extubation time and orientation recovery time of the study group were shorter than those of the control group,the differences were statistically significant(P＜0.05).At To,there was no statisti-cally significant difference in mean arterial pressure and heart rate between the two groups(P＞0.05).The mean arterial pressure and heart rate of the study group at T1 were higher than those of the control group,and the mean arterial pressure and heart rate at T2 and T3 were lower than those of the control group,the differences were statistically significant(P＜0.05).At 30 min and 2 h after operation,the Ramsay score of the study group was higher than that of the control group,and the differences were statistically significant(P＜0.05).However,there was no statis-tically significant difference in Ramsay score at 6,12 and 24 h after operation(P＞0.05).At 30 min,2 h,6 h,12 h and 24 h after operation,the VAS scores of the study group were lower than those of the control group,and the differences were statistically significant(P＜0.05).Imme-diately after operation,1 d and 3 d after operation,the levels of serum PI3 K and AKT in the study group were lower than those in the control group,the differences were statistically significant(P＜0.05).There was no statistically significant difference in the incidence of total adverse reactions between the two groups(P＞0.05).Conclusion The application of esketamine combined with propofol general anesthesia induction in laparoscopic gallbladder surgery has positive effects on the vital signs,anesthesia recovery process and postoperative pain control in elderly pa-tients.The control of pain is related to the regulation of PI3K/AKT signaling pathway,which can provide a potential effective strategy for clinical anesthesia management.
基金项目
安徽省公共卫生临床中心科研培育基金(2023YKJ10)
安徽医科大学校科研基金(2023xkj049)
NETL
NSTL
万方数据