摘要
目的 比较以腰方肌阻滞联合艾司氯胺酮为主的低阿片化麻醉策略对腹腔镜结肠癌根治术患者术后恢复的影响。方法 选择择期在全麻下行腹腔镜结肠癌根治术患者138例,男72例,女66例,年龄45~75岁,BMI 18.5~25.0 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为三组:对照组(C组)、低阿片化麻醉策略组(L组)和无阿片化麻醉策略组(F组),每组46例。C组采用舒芬太尼和丙泊酚行麻醉诱导,采用丙泊酚和瑞芬太尼行麻醉维持。L组和F组麻醉开始前在超声引导下行双侧腰方肌阻滞,采用艾司氯胺酮、丙泊酚和利多卡因行麻醉诱导。L组采用艾司氯胺酮和低剂量瑞芬太尼、丙泊酚和利多卡因行麻醉维持,F组采用艾司氯胺酮、丙泊酚和利多卡因行麻醉维持。分别于术前1 d、术后1、3、7、30 d记录15项恢复质量量表(QoR-15)评分。记录术中药物用量、术后2、6、12、24、48 h静息和活动时NRS疼痛评分、术后48 h内镇痛泵有效按压次数和总按压次数、补救镇痛情况。记录苏醒时间、PACU停留时间、术后首次肛门排气时间、术后首次下床活动时间、术后住院时间和术后并发症的发生情况。结果 与C组比较,L组和F组术后1、3、7 d身体舒适度、情绪状态评分和QoR-15总分明显升高,术后1、3 d疼痛情况评分明显升高,术后2、6、12、24、48 h静息和活动时NRS疼痛评分明显降低,术后48 h内镇痛泵有效按压次数和总按压次数明显减少,补救镇痛率明显降低,术后首次肛门排气时间、术后首次下床活动时间及术后住院时间明显缩短,术后恶心呕吐发生率明显降低(P<0.05)。与L组比较,F组术中艾司氯胺酮用量明显增加,苏醒时间和术后PACU停留时间明显延长(P<0.05)。结论 腰方肌阻滞联合艾司氯胺酮为主的低阿片化麻醉策略,不延长患者苏醒时间,可以提高腹腔镜结肠癌根治术患者术后早期恢复质量。
Objective To compare the effects of low-opioid anesthesia strategies,primarily combining quadratus lumborum block with esketamine,on postoperative recovery in patients undergoing laparoscopic radical resection for colon cancer.Methods A total of 138 patients scheduled for laparoscopic radical resection for colon cancer under general anesthesia,72 males and 66 females,aged 45-75 years,BMI 18.5-25.0 kg/m^(2),ASA physical statusⅡorⅢ,were selected and divided into three groups by random number table method:the control group(group C),the low-opioid anesthesia strategy group(group L),and the opioid-free anesthesia strategy group(group F),46 patients in each group.Group C received sufentanil and propofol for induction,followed by propofol and remifentanil for maintenance.Groups L and F received ultrasound-guided quadratus lumborum block before anesthesia induction,and induced by esketamine,propofol,and lidocaine.Group L received esketamine,and low-dose remifentanil,propofol,and lidocaine for maintenance,while group F received esketamine,propofol,and lidocaine for maintenance.The QoR-15 scale score was recorded 1 day before operation,1 day,3,7,and 30 days after operation.The intraoperative drug consumption,NRS scores at rest and during activity 2,6,12,24,and 48 hours after operation,the effective and total number compressions of analgesic pump and the rescue analgesia within 48 hours postoperatively were recorded.The recovery time,PACU residence time,the time of first postoperative exhaust,the first time to get out of bed,and the length of hospital stay were also recorded.Postoperative complications until discharge were recorded.Results Compared with group C,the physical comfort,emotional state scores,and total QoR-15 score 1 day,3 and 7 days after surgery were significantly increased,the pain scores 1 day and 3 days after surgery were significantly increased,the NRS scores at rest and during activity 2,6,12,24,and 48 hours after surgery were significantly decreased,the effective and total number compressions of analgesic pump,the rescue analgesia rate within 48 hours postoperatively were significantly decreased,the time of first postoperative exhaust,the first time to get out of bed,and the length of hospital stay were significantly shortened,the incidence of postoperative nausea and vomiting was significantly decreased in groups L and F(P<0.05).Compared with group L,the consumption of esketamine were significantly increased,the recovery time and PACU residence time in group F were significantly prolonged(P<0.05).Conclusion Low-opioid anesthesia strategy combining quadratus lumborum block with esketamine improves short-term postoperative recovery quality in patients undergoing laparoscopic radical resection for colon cancer without affecting the recovery of patients.
作者
程传喜
刘彦
王凯
杨少杰
舒爱华
周密
陈小波
CHENG Chuanxi;LIU Yan;WANG Kai;YANG Shaojie;SHU Aihua;ZHOU Mi;CHEN Xiaobo(The First College of Clinical Medical Science,China Three Gorges University&Department of Anesthesiology,Yichang Central People's Hospital&Institute of Geriatric Anesthesiology,Three Gorges University,Yichang 443000,China)
出处
《临床麻醉学杂志》
北大核心
2025年第10期1046-1052,共7页
Journal of Clinical Anesthesiology
基金
宜昌市医疗卫生研究项目(A23-1-030)。
关键词
腰方肌阻滞
艾司氯胺酮
低阿片化麻醉
无阿片化麻醉
恢复质量
Quadratus lumborum block
Esketamine
Low-opioid anesthesia
Opioid-free anesthesia
Quality of recovery
