Effect of Esketamine Combined with Parecoxib Sodium on Postoperative Recovery Quality in Elderly Patients Undergoing Laparoscopic Radical Resection of Gastrointestinal Malignant Tumor
Objective To investigate the effect of esketamine combined with parecoxib sodium on postoperative recovery quality in elderly patients undergoing laparoscopic radical resection of gastrointestinal malignant tumor.Methods From August 2022 to February 2023,elderly patients undergoing laparoscopic radical resection of gastrointestinal malignant tumor under general anesthesia in Chaohu Hospital of Anhui Medical University were selected.The patients were divided into parecoxib sodium group(group P,n=31),esketamine group(group E,n=31),parecoxib sodium combined with esketamine group(group PE,n=32)by random number table method.In group P,40 mg parecoxib sodium was injected 15 min before anesthesia induction.In group E,0.25 mg/kg of esketamine was injected before anesthesia induction,and the anesthesia was maintained at a speed of 0.25 mg/(kg·h)until 30 min before the end of surgery.The group PE was combined with two drugs according to the method of group P and group E.Propofol and remifentanil were used for total intravenous anesthesia in the three groups,and sufentanil intravenous analgesia pump was used after operation.The quality of recovery[quality of recovery scale(QoR-40)],laboratory indexes[epinephrine(N),norepinephrine(NE),interleukin(IL)-2,IL-6,tumor necrosis factor-a(TNF-a)]before anesthesia induction(To),at the end of operation(T1)and 24 h after operation(T2),operation time,dosage of propofol and remifentanil during operation,recovery time,extubation time,first exhaust time after operation,first time to get out of bed after operation,total pressing times of analgesia pump 48 h after operation,effective pressing times,number of remedial analgesia cases,VAS pain scores at rest and during activity,and incidence of postoperative adverse reactions were compared among the three groups.Results The physical comfort score,emotional state score,pain score and total score of the group PE on the 1st,3rd and 7th day after operation were higher than those of the group P and the group E(P＜0.05).There was no significant difference in the scores of self-care ability and psychological support among the three groups(P＞0.05).The contents of plasma N,NE,IL-6 and TNF-α at T1 and T2 in the three groups were higher than those at To,and the content of plasma IL-2 was lower than that at To,while the contents of plasma N,NE,IL-6 and TNF-α at T1 and T2 in the group PE were lower than those in the group P and the group E,and the content of IL-2 was higher than that in the group P and the group E(P＜0.05).The dosage of propofol and remifentanil in group PE was less than that in group P and group E(P＜0.05),but there was no significant difference in operation time,recovery time and extubation time among the three groups(P＞0.05).The first time of getting out of bed,the first time of exhaust,the total number of pressing times of analgesic pump and the number of effective pressing times in group PE were lower than those in group P and group E(P＜0.05),but there was no significant difference in the proportion of remedial analgesia among the three groups(P＞0.05).The resting and exercise VAS scores of group PE at 12,24 and 48 h after operation were lower than those of group P and group E(P＜0.05).There was no significant difference in the incidence of nausea and vomiting,drowsiness,respiratory depression and hypotension within 24 h after operation among the three groups(P＞0.05).Conclusion In elderly patients undergoing laparoscopic radical resection of gastrointestinal malignant tumor,esketamine combined with parecoxib sodium can effectively improve the quality of postoperative recovery,reduce perioperative stress inflammatory response and early postoperative pain.
万方数据
维普
