摘要
目的 探讨常规麻醉联合小剂量艾司氯胺酮对腹腔镜全子宫切除术患者疼痛、应激反应的影响.方法 选取定州市人民医院2022年1月至2023年12月收治的腹腔镜全子宫切除术患者150例为研究对象,使用随机数字表法将所有患者分为对照组及观察组,每组75例.对照组采用常规麻醉方案,观察组在其基础上加用小剂量艾司氯胺酮.比较两组患者术中镇静、不同时刻血流动力学、术后疼痛、应激反应相关指标及不良反应发生率.结果 两组入室、插管、切皮血流动力学比较差异无统计学意义(P＞0.05),观察组拔管、出室时平均动脉压(mean arterial pressure,MAP)为(94.84±6.02)、(86.14±5.99)mmHg,收缩压(systol-ic blood pressure,SBP)为(96.48±5.72)、(96.48±5.69)mmHg,心率(heart rate,HR)为(95.51±5.95)、(84.05±5.57)次/min;对照组分别为(102.05±6.13)、(93.71±6.25)、(105.03±6.07)、(104.37±6.02)mmHg,(102.49±6.87)、(90.51±5.86)次/min,观察组显著低于对照组(P＜0.05).观察组拔管、出室时SpO2为(97.47±1.24)％、(98.11±1.24)％,对照组为(96.32±1.21)％、(97.03±1.23)％,观察组显著高于对照组(P＜0.05).观察组术后3h、6h、12h、24 h VAS 评分为(1.71±0.35)、(2.58±0.53)、(3.27±0.68)、(3.86±0.82)分,对照组为(2.13±0.42)、(3.74±0.75)、(4.52±1.01)、(4.53±1.04)分,观察组显著低于对照组(P＜0.05).观察组5-羟色胺(5-hydroxy-tryptamine,5-HT)、P物质(substance P,SP)、去甲肾上腺素(norepinephrine,NE)水平为(29.53±7.68)、(37.44±8.16)、(49.71±9.56)ng/mL,对照组为(52.81±10.04)、(54.62±10.25)、(61.23±10.08)ng/mL,观察组显著低于对照组(P＜0.05).术后2 d观察组降钙素基因相关肽(calcitonin gene related peptide,CGRP)、神经肽Y(neu-ropeptide Y,NPY)、皮质醇(cortisol,Cor)水平为(158.41±27.06)μg/mL、(127.84±24.21)μg/mL、(240.37±31.55)nmol/L,对照组为(175.49±30.28)μg/mL、(153.92±28.63)μg/mL、(251.18±34.92)nmol/L,观察组显著低于对照组(P＜0.05).观察组不良反应发生率为10.67％(8/75),对照组为16.00％(12/75),两组比较差异无统计学意义(P＞0.05).结论 常规麻醉联合小剂量艾司氯胺酮有助于降低腹腔镜全子宫切除术患者术中血流动力学变化,提高镇静效果,缓解患者术后疼痛,降低患者术后疼痛因子及氧化应激相关指标水平且不增加不良反应,具有较好疗效及安全性.
Abstract
Objective To investigate the effects of conventional anesthesia combined with low dose esket-amine on pain and stress response in patients undergoing laparoscopic total hysterectomy.Methods A total of 150 patients with laparoscopic total hysterectomy admitted to our hospital from Jan.2022 to Dec.2023 were select-ed as subjects.All patients were divided into control group and study group by coin toss method,with 75 cases in each group.The control group were given conventional anesthesia,and the study group were given a small dose of esketamine.Intraoperative sedation,hemodynamics at different times,postoperative pain,stress response and the incidence of adverse reactions were compared between the two groups.Results There was no significant differ-ence in hemodynamics between the two groups(P＞0.05).Mean arterial pressure(MAP)was(94.84±6.02),(86.14±5.99)mmHg,systolic blood pressure(SBP)was(96.48±5.72),(96.48±5.69)mmHg;Heart rate(HR)was 95.51±5.95,84.05±5.57 times/min,while they were 102.05±6.13,93.71±6.25,105.03±6.07,104.37±6.02 mmHg,102.49±6.87,90.51±5.86 times/min,respectively in the control group.The study group was significantly lower than the control group(P＜0.05).SpO2 at extubation and extravasation were(97.47±1.24)％and(98.11±1.24)％in study group and(96.32±1.21)％and(97.03±1.23)％in the control group,significantly higher than those in the control group(P＜0.05).VAS scores at 3 h,6 h,12 h and 24 h were 1.71±0.35,2.58±0.53,3.27±0.68,3.86±0.82 in the study group and 2.13±0.42,3.74±0.75,4.52±1.01,4.53±1.04 in the control group.The study group was significantly lower than the control group(P＜0.05).Study group 5-hydroxytryptamine(5-HT),sub-stance P(SP),norepinephrine,NE)levels were 29.53±7.68,37.44±8.16,49.71±9.56 ng/mL,and 52.81±10.04,54.62±10.25,61.23±10.08 ng/mL in the control group,significantly lower than those in the control group(P＜0.05).Postoperative 2 d study group calcitonin gene related peptide(calcitonin gene related peptide,CGRP),neu-ropeptide Y(NPY)and cortisol(Cor)levels were 158.41±27.06 μg/mL,127.84±24.21 μg/mL and 240.37±31.55 nmol/L.The control group was 175.49±30.28 μg/mL,153.92±28.63 μg/mL,251.18±34.92 nmol/L,and the study group was significantly lower than the control group(P＜0.05).The incidence of adverse reactions in the study group was 10.67％(8/75),and the control group was 16.00％(12/75),with no statistical significance(P＞0.05).Conclusion Conventional anesthesia combined with low-dose esketamine can help reduce intraoperative hemody-namic changes in patients with laparoscopic total hysterectomy,improve sedation effect,relieve postoperative pain,reduce postoperative pain factors and oxidative stress related indexes of patients without increasing adverse reac-tions,and has good efficacy and safety.
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