目的:探讨艾司氯胺酮联合腹横筋膜阻滞(TAPB)在妇科腹腔镜手术中的应用,以及对患者术后疼痛与康复的影响.方法:将2021年1月-2023年12月本我院妇科行腹腔镜手术患者100例随机纳入T组、ET组各50例,T组予以TAPB麻醉,ET组予以艾司氯胺酮联合TAPB麻醉.观察两组术中麻醉药用量(丙泊酚、瑞芬太尼)、苏醒质量(拔管时间、恢复室停留时间)、术后疼痛(VAS评分)、康复指标(排气时间、下床活动时间、术后住院时间)、血清学指标白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、神经元特异性烯醇化酶(NSE)、不良反应.结果:ET组术中丙泊酚剂量(402.69±27.27 mg)、瑞芬太尼剂量(1.21±0.19 mg)、拔管时间(12.06±2.10 min)、恢复室停留时间(30.66±6.41 min)均少于 T 组(425.24±30.68 mg、1.60±0.25 mg、17.35±2.73 min、35.29±7.23 min),术后 2h、6h、12h、24h、48hVAS评分均低于T组,排气(30.62±5.78h)、下床活动(35.50±6.21h)、术后住院时间(4.96±1.00d)均少于T组(36.41±6.15h、42.14±6.93h、5.61±1.14d),两组术后 1d IL-6、TNF-α、NSE 均高于术前但 ET 组均低于 T 组,不良反应发生率(6.0％)低于T组(20.0％)(均P＜0.05).结论:艾司氯胺酮联合TAPB用于妇科腹腔镜手术中的麻醉效果较好,可减少麻醉维持药量,提高苏醒质量,减轻术后疼痛,有助于术后康复,且能改善血清学指标,减少不良反应.
Impact of esketamine combined with propofol and remifentanil transversus abdominis plane block during gynecological lap-aroscopic surgery of patients on their postoperative pain and recovery
Objective:To explore the application of ketamine combined with propofol and remifentanil transversus abdo-minis plane block(TAPB)during gynecological laparoscopic surgery of patients,and to study its impact on the postop-erative pain and rehabilitation of the patients.Methods:100 patients who wanted laparoscopic surgery admitted to the gynecology department of the hospital were selected and were randomly divided into two groups(50 cases in each group)from January 2021 to December 2023.The patients in group A received propofol and remifentanil TAPB anes-thesia,while the patients in group B received ketamine combined with propofol and remifentanil TAPB anesthesia.The dosage of anesthetics(propofol and remifentanil),the recovery quality,such as the extubation time and the stay time in the recovery room,the postoperative pain evaluated by VAS score,the recovery indicators,such as the exhaust time,the time of getting out of bed and the duration of the postoperative hospital stay,the levels of serological indica-tors,such as interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and neuron-specific enolase(NSE),and the ad-verse reactions rate of the patients in the two groups were observed.Results:The dosages of intraoperative propofol used(402.69±27.27 mg)and remifentanil(1.21±0.19 mg),the extubation time(12.06±2.10 min)and the stay time in the recovery room(30.66±6.41 min)of the patients in group B were significantly less than those(425.24±30.68 mg,1.60±0.25 mg,17.35±2.73 min and 35.29±7.23 min)of the patients in group A.The VAS scores of the pa-tients in group B at postoperative 2h,6h,12h,24h and 48h were significantly lower than those of group A.The time of exhaust(30.62±5.78 h),the time of getting out of bed(35.50±6.21 h)and the duration of the postoperative hospi-tal stay(4.96±1.00 d)of the patients in group B were significantly less than those(36.41±6.15 h,42.14±6.93 h and 5.61±1.14 d)of the patients in group A.The levels of IL-6,TNF-α and NSE of the patients in the two groups in post-operative 1 day were significantly higher than those before operation,but which of the patients in group B were signifi-cantly lower than those of the patients in group A.The incidence of adverse reactions(6.0％)of the patients in group B was significantly lower than that(20.0％)of the patients in group A(all P＜0.05).Conclusion:Ketamine combined with propofol and remifentanil TAPB used during gynecological laparoscopic surgery of the patients has better anes-thetic effect,which can reduce the amount of their anesthesia maintenance medication,improve their awakening quali-ty,alleviate their postoperative pain,aid their postoperative rehabilitation,improve their serological indicators and re-duce their adverse reactions.
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