预先静脉注射艾司氯胺酮对腹腔镜胆囊切除术患者术后疼痛效果及并发症的影响

doi:10.3969/j.issn.1006-6233.2022.11.028

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Abstract Objective: To observe the influence of pre-intravenous injection of esketamine on postoperative pain effect and complications in patients undergoing laparoscopic cholecystectomy (LC).Methods: A total of 102 patients undergoing elective LC in the hospital between January 2021 and January 2022 were selected as the observation subjects, and they were numbered according to the order of admission and divided into the esketamine group (odd number) and the routine anesthesia group (even number) by the odd-even number method, with 51 cases in each group. Both groups underwent LC surgery, and the esketamine group was intravenously injected with esketamine at 5 min before anesthesia induction, while the routine anesthesia group was intravenously injected with an equal volume of normal saline. Anesthesia-related indicators, vital signs [mean arterial pressure (MAP), heart rate (HR)] after induction of anesthesia (T0), during pneumoperitoneum (T1), at 5 min after pneumoperitoneum (T2), at 5 min after deflation (T3) and after the end of surgery (T4), pain degree score at different time points after surgery, immune function indicators [CD3⁺(%), CD4⁺(%), CD8⁺(%), CD4⁺/CD8⁺] after awake extubation after the end of surgery and occurrence of postoperative complications were compared between the two groups. Results: The intraoperative propofol dosage and remifentanil dosage in the esketamine group were significantly less or lower than those in the routine anesthesia group (P<0.05), and the laryngeal mask removal time and postoperative awakening time were significantly shorter than those in the routine anesthesia group (P<0.05). MAP at T1, T3 and T4 in both groups were significantly lower than those at T0 (P<0.05), and the MAP at T1, T3 and T4 in the esketamine group was significantly higher than that in the routine anesthesia group (P<0.05). There was a significant difference in HR at T1 and T3 in esketamine group and at T1, T2, T3 and T4 in routine anesthesia group compared with that at T0 (P<0.05), but there was no statistical significance in HR between the groups (P>0.05). At 2 h, 6 h, 12 h and 24 h after surgery, the postoperative pain scores in both groups showed a trend of first increasing and then decreasing (P<0.05), and the pain scores at various time points were significantly lower in the esketamine group than those in the routine anesthesia group (P<0.05). After awake extubation after the end of surgery, the levels of immune function indicators in both groups were decreased, and the levels of CD3⁺(%), CD4⁺(%) and CD4⁺/CD8⁺ were significantly decreased (P<0.05), but the decreases of above levels in the esketamine group were significantly lower compared with those in the routine anesthesia group (P<0.05). The total incidence rate of postoperative complications of 11.76% in the esketamine group was significantly lower than 27.45% in the routine anesthesia group. Conclusion: Pre-intravenous injection of esketamine can reduce the dosages of intraoperative anesthetics in patients with LC, relieve the postoperative pain and immune function inhibition, and reduce the incidence of complications.

Key words： Laparoscopic cholecystectomy Pre-intravenous injection Esketamine Postoperative pain Complications

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2022.11.028 OR http://www.hbyxzzs.cn/EN/Y2022/V28/I11/1896

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