摘要
目的 评价术前静注艾司氯胺酮对腹腔镜结直肠癌根治术患者术后疲劳综合征(POFS)的影响.方法 选择 2021 年 6 月至 2022 年 7 月择期行腹腔镜结直肠癌根治术患者 62 例,男41 例,女21 例,年龄34～64 岁,BMI 18～25 kg/m2,ASAⅠ或Ⅱ级.采用随机数字表法将患者分为两组:艾司氯胺酮组(E组)和对照组(C组),每组 31 例.手术开始前 5minE组静脉注射艾司氯胺酮 0.25 mg/kg(用生理盐水配成 5 ml),C组静脉注射生理盐水 5 ml.两组术后静脉镇痛方案相同.于麻醉诱导前 10 min、术后即刻、12、24 h抽取颈内静脉血样,检测血清肿瘤坏死因子-α(TNF-α)、超氧化物歧化酶(SOD)浓度.于术前 1d、术后3、5、7 d进行简明围术期疲劳评定量表(ICFS-10)评分,记录POFS(ICFS-10 评分＞24 分)发生情况.记录拔管时间、拔管后呛咳、苏醒期谵妄和躁动等不良反应、术后各系统并发症的发生情况、术后住院时间.结果 与C组比较,E组术后即刻、术后 12、24 h血清TNF-α浓度明显降低(P＜0.05),SOD浓度明显升高(P＜0.05);术后 3、5、7 d ICFS-10 评分、术后 7 d POFS发生率明显降低(P＜0.05).两组拔管时间、拔管后呛咳、苏醒期谵妄和躁动、术后各系统并发症发生率、术后住院时间差异均无统计学意义.结论 术前单次静脉注射艾司氯胺酮可降低腹腔镜结直肠癌根治术患者术后血清TNF-α、SOD浓度和POFS的发生率,未增加不良反应.
Abstract
Objective To investigate the impact of intravenous inject esketamine before operation on postoperative fatigue syndrome(POFS)in patients undergoing laparoscopic radical surgery for colorectal cancer.Methods Sixty-two patients,41 males and 21 females,aged 34-64 years,BMI 18-25 kg/m2,ASA physical statusⅠ orⅡ,scheduled for laparoscopic radical surgery for colorectal cancer under general anesthesia,were randomly assigned into two groups:the esketamine group(group E)and the control group(group C),31 patients in each group.Group E received a single intravenous injection of esketamine 0.25 mg/kg 5 minutes before surgery,while group C received sodium chloride 5 ml.The intravenous analgesia program was identical between the two groups.The jugular venous blood samples were taken for determination of serum concentrations of tumor necrosis factor-α(TNF-α)and superoxide dismutase(SOD)10 minutes before anesthesia,at the end of operation,and 12 and 24 hours after operation.Identity-consequence fatigue scale(ICFS-10)score were performed 1 day before surgery,3,5,and 7 days after op-eration,respectively,and the occurrence of POFS(ICFS-10 score＞24 points)were recorded.The time of extubation and the occurrence of adverse reactions such as coughing,delirium and restlessness during awak-ening,the complications of systems postoperatively,and the postoperative hospitalization time were recorded.Results Compared with group C,the concentration of serum TNF-α were significantly decreased while the concentration of serum SOD were significantly increased at the end of operation,12 and 24 hours after operation(P＜0.05),ICFS-10 score 3,5,and 7 days after operation,and the incidence of POFS 7 days after operation were significantly decreased(P＜0.05).There were no significant differences in extu-bation time,coughing,delirium and restlessnes,the complications postoperatively,and postoperative hospi-talization time between the two groups.Conclusion A single intravenous injection of esketamine can reduce the incidence of POFS in patients undergoing laparoscopic radical surgery for colorectal cancer,and no postoperative adverse reactions increased.
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