摘要
目的探究艾司氯胺酮亚麻醉剂量对老年腹腔镜胃癌手术患者的镇痛效果及对脑组织的保护作用。方法选取2023年8月至2024年7月郑州颐和医院收治的102例老年胃癌患者作为研究对象,按随机数表法分为观察组和对照组各51例。腹腔镜胃癌手术中观察组于麻醉诱导时持续静脉泵注0.25 mg/(kg·h)艾司氯胺酮,麻醉维持时静脉泵注0.25 mg/(kg·h)艾司氯胺酮至手术结束前30 min,对照组在相应时点给予等量生理盐水,其余所用麻醉诱导及维持药物相同。比较两组患者的康复指标、不同时间点平均动脉压(MAP)、心率(HR)、脑氧代谢指标、脑组织损伤标志物[中枢神经特异性蛋白(S100β)、人β淀粉样蛋白1-42(Aβ1-42)、微管相关蛋白tau(Tau)]、视觉模拟评分法(VAS)评分和神经认知障碍(PND)发生率。结果观察组患者的术后住院时间为(5.86±1.04)d,明显短于对照组的(7.12±1.23)d,差异有统计学意义(P<0.05);两组患者睁眼时间、拔管时间、PACU停留时间比较差异均无统计学意义(P>0.05);切皮前即刻(T1)、手术15 min时(T2)、手术结束时(T3)时,观察组患者的MAP、HR水平明显低于对照组,T2、T3时,观察组患者的脑氧摄取率(CERO_(2))、动脉-颈内静脉血氧含量差(Da-jvO_(2))水平明显低于对照组,颈内静脉血氧含量(CjvO_(2))水平明显高于对照组,差异均有统计学意义(P<0.05),而术后1 d,两组患者的CjvO_(2)、Da-jvO_(2)、CERO_(2)水平比较差异均无统计学意义(P>0.05);术后1 d、3 d、7 d,观察组患者的血清Aβ1-42、S100β、Tau蛋白水平明显低于对照组,差异均有统计学意义(P<0.05);术后1 d、3 d、7 d,观察组患者的静息、咳嗽时VAS评分明显低于对照组,差异均有统计学意义(P<0.05);术后3 d、1周、2周,观察组的PND发生率明显低于对照组,差异均有统计学意义(P<0.05)。结论在老年腹腔镜胃癌手术中应用亚麻醉剂量艾司氯胺酮患者血流动力学较为平稳,并可有效改善脑氧代谢,减轻术后疼痛程度、脑组织损伤、降低PND发生率,有利于促进术后康复。
Objective To investigate the analgesic effects and neuroprotective effects of sub-anesthetic doses of esketamine in elderly patients undergoing laparoscopic gastrectomy for gastric cancer.Methods A total of 102 elderly patients with gastric cancer admitted to Zhengzhou Yihe Hospital from August 2023 to July 2024 were enrolled and randomly assigned to an observation group and a control group using the random number table method,with 51 patients in each group.During laparoscopic gastrectomy for gastric cancer,patients in the observation group received a continuous intravenous infusion of esketamine 0.25 mg/(kg·h)during anesthesia induction,which was maintained throughout anesthesia and discontinued 30 min before the end of surgery;patients in the control group received an equal volume of normal saline at corresponding time points;all other induction and maintenance drugs were identical in the two groups.Postoperative recovery indices,mean arterial pressure(MAP),heart rate(HR),cerebral oxygen metabolism indicators,brain tissue injury markers(central nervous system-specific protein[S100β],humanβ-amyloid 1-42[Aβ1-42],microtubule-associated protein tau[Tau]),Visual Analog Scale(VAS)scores,and the incidence of postoperative neurocognitive disorder(PND)at different time points were compared between the two groups.Results The postoperative hospital stay was(5.86±1.04)days in the observation group,significantly shorter than(7.12±1.23)days in the control group(P<0.05).There were no statistically significant differences in eye opening time,extubation time,and PACU(post-anesthesia care unit)stay time between the two groups(P>0.05).Immediately before skin incision(T1),15 minutes into the surgery(T2),and at the end of the surgery(T3),MAP and HR were significantly lower in the observation group compared to the control group(all P<0.05).At T2 and T3,cerebral oxygen extraction ratio(CERO_(2))and arterio-jugular venous oxygen content difference(Da-jvO_(2))were significantly lower in the observation group,while jugular venous oxygen content(CjvO_(2))was significantly higher compared to the control group(P<0.05);no between-group differences were observed 24 h post-operatively(P>0.05).On postoperative days 1,3,and 7,the serum levels of Aβ1-42,S100β,and Tau protein were significantly lower in the observation group compared to the control group(P<0.05);resting and coughing VAS scores were significantly lower in the observation group compared to the control group at these same time points(P<0.05).Additionally,the incidence of PND was significantly lower in the observation group than in the control group at postoperative day 3,1 week,and 2 weeks(P<0.05).Conclusion In elderly patients undergoing laparoscopic gastrectomy,intra-operative administration of a sub-anesthetic dose of esketamine provides more stable hemodynamics,effectively improves cerebral oxygen metabolism,alleviates postoperative pain and cerebral injury,decreases the incidence of PND,and thereby promotes postoperative recovery.
作者
方旭辉
丁绍林
邓芳
FANG Xu-hui;DING Shao-Lin;DENG Fang(Department of Anesthesiology,Zhengzhou Yihe Hospital,Zhengzhou 450000,Henan,CHINA)
出处
《海南医学》
2025年第11期1550-1555,共6页
Hainan Medical Journal
基金
2023年度河南省医学科技攻关计划联合共建项目(编号:LHGJ20230436)。
关键词
老年人
胃癌
腹腔镜
胃癌根治术
艾司氯胺酮
亚麻醉剂量
脑保护
Elderly
Gastric cancer
Laparoscopy
Radical gastrectomy
Esketamine
Sub-anesthetic dose
Neuroprotection
