[1]林容木,章 锐,雷程雯,等.艾司氯胺酮联合帕瑞昔布钠对腹腔镜胃肠道恶性肿瘤根治术老年患者术后恢复质量的影响[J].医学信息,2024,37(06):84-90.[doi:10.3969/j.issn.1006-1959.2024.06.014]
　LIN Rong-mu,ZHANG Rui,LEI Cheng-wen,et al.Effect of Esketamine Combined with Parecoxib Sodium on Postoperative Recovery Quality in Elderly Patients Undergoing Laparoscopic Radical Resection of Gastrointestinal Malignant Tumor[J].Journal of Medical Information,2024,37(06):84-90.[doi:10.3969/j.issn.1006-1959.2024.06.014]
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艾司氯胺酮联合帕瑞昔布钠对腹腔镜胃肠道恶性肿瘤根治术老年患者术后恢复质量的影响()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
37卷
期数:
2024年06期
页码:
84-90
栏目:
论著
出版日期:
2024-03-15

文章信息/Info

Title:
Effect of Esketamine Combined with Parecoxib Sodium on Postoperative Recovery Quality in Elderly Patients Undergoing Laparoscopic Radical Resection of Gastrointestinal Malignant Tumor
文章编号:
1006-1959（2024）06-0084-07
作者:
林容木; 章 锐; 雷程雯; 等
（安徽医科大学附属巢湖医院麻醉科，安徽 合肥 238000）
Author(s):
LIN Rong-mu; ZHANG Rui; LEI Cheng-wen; et al.
(Department of Anesthesiology,Chaohu Hospital of Anhui Medical University,Hefei 238000,Anhui,China)
关键词:
艾司氯胺酮; 帕瑞昔布钠; 胃肠道恶性肿瘤; 术后恢复质量
Keywords:
Esketamine; Paroxicib sodium; Gastrointestinal malignant tumor; Postoperative recovery quality
分类号:
R614.2
DOI:
10.3969/j.issn.1006-1959.2024.06.014
文献标志码:
A
摘要:
目的 探讨艾司氯胺酮联合帕瑞昔布钠对腹腔镜胃肠道恶性肿瘤根治术老年患者术后恢复质量的影响。方法 选择2022年8月-2023年2月安徽医科大学附属巢湖医院择期行全麻下腹腔镜胃肠道恶性肿瘤根治术老年患者,采用随机数字表法将患者分为帕瑞昔布钠组（P组，n=31）、艾司氯胺酮组（E组，n=31）、帕瑞昔布钠联合艾司氯胺酮组（PE组，n=32）。P组麻醉诱导前15 min注射帕瑞昔布钠40 mg；E组麻醉诱导前注射艾司氯胺酮0.25 mg/kg，麻醉维持期以0.25 mg/（kg·h）的速度泵注至手术结束前30 min；PE组按照P组和E组的方法联合使用两种药物，三组术中采用丙泊酚和瑞芬太尼全凭静脉麻醉，术后均用舒芬太尼静脉镇痛泵。比较三组恢复质量[恢复质量评分量表（QoR-40）]、麻醉诱导前（T0）、手术结束时（T1）、术后24 h（T2）实验室指标[肾上腺素（N）、去甲肾上腺（NE）、白介素（IL）-2、IL-6、肿瘤坏死因子α（TNF-α）]、手术时间、术中丙泊酚和瑞芬太尼用量、苏醒时间、拔管时间、术后首次排气时间、术后首次下床时间、术后48 h镇痛泵总按压次数、有效按压次数、补救镇痛例数、静息时和活动时VAS疼痛评分、术后不良反应发生情况。结果 PE组术后1、3、7 d身体舒适度、情绪状态、疼痛评分及总评分均高于P组、E组（P＜0.05），而三组自理能力、心理支持评分比较，差异无统计学意义（P＞0.05）。三组T1、T2时血浆N、NE、IL-6、TNF-α含量高于T0时、血浆IL-2含量低于T0时，而PE组T1、T2时血浆N、NE、IL-6、TNF-α含量低于P组、E组，IL-2含量高于P组、E组（P＜0.05）。PE组术中丙泊酚、瑞芬太尼用量少于P组、E组（P＜0.05），而三组手术时间、苏醒时间、拔管时间比较，差异无统计学意义（P＞0.05）。PE组术后首次下床时间、首次排气时间、镇痛泵总按压次数、有效按压次数低于P组、E组（P＜0.05），而三组补救镇痛比例比较，差异无统计学意义（P＞0.05）。PE组术后12、24、48 h静息及运动VAS评分低于P组、E组（P＜0.05）。三组术后24 h内恶心呕吐、嗜睡、呼吸抑制、低血压发生率比较，差异无统计学意义（P＞0.05）。结论 在腹腔镜胃肠道恶性肿瘤根治术老年患者中，采用艾司氯胺酮联合帕瑞昔布钠可有效改善术后恢复质量，减轻围术期应激炎症反应，降低术后早期疼痛。
Abstract:
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-α (TNF-α)] before anesthesia induction (T0), 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 T0, and the content of plasma IL-2 was lower than that at T0, 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.

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更新日期/Last Update: 1900-01-01