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亚麻醉剂量艾司氯胺酮对腹腔镜胆囊切除术患者术后焦虑及恢复的影响
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| 篇名： | 亚麻醉剂量艾司氯胺酮对腹腔镜胆囊切除术患者术后焦虑及恢复的影响 |
| TITLE： | Effects of subanesthetic dose of esketamine on postoperative anxiety and recovery in patients undergoing laparo-scopic cholecystectomy |
| 摘要： | 目的 探讨亚麻醉剂量艾司氯胺酮对腹腔镜胆囊切除术患者术后焦虑及恢复的影响。方法选择2023年1月到2024年12月于苏州大学附属苏州九院行腹腔镜胆囊切除术患者200例，按随机数字表法分为对照组和观察组，每组100例。麻醉开始前1min，对照组患者静脉注射丙泊酚乳状注射液+枸橼酸舒芬太尼注射液+氯化琥珀胆碱注射液；观察组患者在此基础上，静脉注射盐酸艾司氯胺酮注射液。比较两组患者的焦虑状态，术中一般情况（舒芬太尼用量、气腹持续时间、手术时间、麻醉时间和拔管时间），术后恢复情况、不良反应发生情况及地佐辛补救镇痛情况；不同时间点的心率、平均动脉压、熵指数（状态熵、反应熵）、炎症因子水平（白细胞介素6、C反应蛋白）、疼痛程度的数字评分（NRS）。结果两组患者的气腹持续时间、手术时间、麻醉时间、拔管时间、术后口干发生率、熵指数、出室时间比较，差异均无统计学意义（P＞0.05）。与对照组比较，观察组患者术后状态-特质焦虑问卷评分，术中舒芬太尼用量，术后恶心、呕吐、寒战的发生率，地佐辛补救镇痛患者比例和术后24h血浆白细胞介素6、C反应蛋白水平，以及NRS均显著减少或降低（P＜0.05）；观察组患者手术开始时、手术结束时、拔管时的心率和平均动脉压均显著高于对照组（P＜0.05）。结论亚麻醉剂量艾司氯胺酮可有效减轻腹腔镜胆囊切除术患者的术后焦虑、减少术中阿片类药物用量、抑制术后炎症反应、缓解术后疼痛并促进术后恢复。 |
| ABSTRACT： | OBJECTIVE To investigate the effects of subanesthetic dose of esketamine on postoperative anxiety and recovery in patients undergoing laparoscopic cholecystectomy. METHODS A total of 200 patients scheduled for laparoscopic cholecystectomy at Suzhou Ninth Hospital Affiliated to Soochow University from January 2023 to December 2024 were randomly assigned to control group （n＝100） and observation group （n＝100）. One minute before the initiation of anesthesia， patients in the control group received intravenous injections of Propofol emulsion injection， Sufentanil citrate injection， and Succinylcholine chloride injection. On this basis， patients in the observation group received an intravenous injection of Esketamine hydrochloride injection. The anxiety status of patients in both groups was compared， along with their general intraoperative conditions （including sufentanil dosage， duration of pneumoperitoneum， operative time， anesthesia time， and extubation time）， postoperative recovery， incidence of adverse reactions， and the need for dezocine rescue analgesia. Heart rate and mean arterial pressure， entropy index （state entropy and response entropy）， inflammatory marker levels [interleukin-6 （IL-6） and C-reactive protein （CRP）]， numerical rating scale （NRS） for pain intensity were compared between the two groups at different time points. RESULTS No significant differences were found between the two groups in pneumoperitoneum duration， operative time， anesthesia time，extubation time， incidence of postoperative dry mouth， entropy index or length of stay in the post-anesthesia care unit （P＞0.05）. Compared with the control group， the observation group showed significantly lower postoperative STAI-S scores， reduced intraoperative sufentanil consumption， decreased incidence of postoperative nausea， vomiting， and shivering， the need for dezocine rescue analgesia， as well as lower plasma IL-6 and CRP levels at 24 h after surgery， and NRS （P＜0.05）. The heart rate and mean arterial pressure of patients in the observation group at the start of surgery， end of surgery， and during extubation were all significantly higher than those in the control group （P＜0.05）. CONCLUSIONS Subanesthetic dose of esketamine can effectively alleviate postoperative anxiety， reduce intraoperative opioid consumption， suppress postoperative inflammatory response， relieve postoperative pain， and promote recovery in patients undergoing laparoscopic cholecystectomy. |
| 期刊： | 2026年第37卷第02期 |
| 作者： | 钟章珍；郑显；徐婷；王洁；曹晖；周兴根；李辉；赵嘉诚；刘慧；张超 |
| AUTHORS： | ZHONG Zhangzhen，ZHENG Xian， XU Ting，WANG Jie，CAO Hui，ZHOU Xinggen，LI Hui，ZHAO Jiacheng，LIU Hui，ZHANG Chao |
| 关键字： | 艾司氯胺酮；焦虑；术后恢复；全身麻醉；亚麻醉剂量；腹腔镜胆囊切除术 |
| KEYWORDS： | esketamine； anxiety； postoperative recovery； general anesthesia； subanesthetic dose； laparoscopic cholecystectomy |
| 阅读数： | 2 次 |
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