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| 右美托咪定复合艾司氯胺酮对腹腔镜胃减容手术患者术后恢复质量的影响 |
| Effect of dexmedetomidine combined with esketamine on the quality of postoperative recovery in patients undergoing laparoscopic gastric volume reduction surgery |
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| DOI：10.12089/jca.2024.08.010 |
| 中文关键词: 右美托咪定 艾司氯胺酮 腹腔镜 胃减容手术 恢复质量 肥胖 |
| 英文关键词: Dexmedetomidine Esketamine Laparoscopy Gastric volume reduction surgery Quality of recovery Obesity |
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| 中文摘要: |
目的：探讨右美托咪定复合艾司氯胺酮对腹腔镜胃减容手术患者术后恢复质量的影响。
方法：选择择期行腹腔镜胃减容手术患者136例，男41例，女95例，年龄18～64岁，BMI 30～45 kg/m2，ASA Ⅱ或Ⅲ级。将患者随机分为四组：右美托咪定复合艾司氯胺酮组（DE组）、艾司氯胺酮组（E组）、右美托咪定组（D组）和对照组（C组），每组34例。麻醉诱导前10 min，DE组和D组泵注右美托咪定0.5 μg/kg，随后以0.4 μg·kg-1·h-1持续泵注至手术结束前40 min。麻醉诱导时，DE组和E组给予艾司氯胺酮0.5 mg/kg负荷剂量，随后以0.1 mg·kg-1·h-1持续泵注至手术结束前40 min，C组在相同时点给予等容量生理盐水。记录术前24 h和术后24 h 40项恢复质量（QoR-40）评分。记录术中丙泊酚和瑞芬太尼用量、术后24 h内地佐辛用量、术后拔管时间、术后首次下床活动时间和术后首次肛门排气时间。记录拔管即刻、术后2、6、12、24 h静息时VAS疼痛评分。记录术后恶心呕吐、躁动、低氧血症和肺炎等不良反应发生情况。
结果：与C组比较，DE组、E组和D组术后24 h QoR-40评分明显升高（P＜0.05），DE组术中丙泊酚和瑞芬太尼用量、术后24 h内地佐辛用量明显减少，术后首次下床活动时间和术后首次肛门排气时间明显缩短（P＜0.05），DE组和E组拔管即刻和术后2、6、12 h静息时VAS疼痛评分明显降低（P＜0.05），D组拔管即刻和术后2 h静息时VAS疼痛评分明显降低（P＜0.05）。与D组比较，DE组术后24 h QoR-40评分明显升高，术中丙泊酚用量明显减少，术后2、6、12 h静息时VAS疼痛评分明显降低（P＜0.05）。与E组比较，DE组术后24 h QoR-40评分明显升高，术中丙泊酚用量明显减少，术后2、6 h 静息时VAS疼痛评分明显降低（P＜0.05）。四组术后24 h静息时VAS疼痛评分和不良反应发生率差异均无统计学意义。
结论：右美托咪定复合艾司氯胺酮可减轻腹腔镜胃减容手术患者术后疼痛，提高术后恢复质量，促进快速康复。 |
| 英文摘要: |
Objective: To investigate the effect of dexmedetomidine combined with esketamine on the quality of postoperative recovery in patients undergoing laparoscopic gastric volume reduction surgery.
Methods: A total of 136 patients undergoing laparoscopic gastric volume reduction surgery, including 41 males and 95 females, aged 18-64 years, BMI 30-45 kg/m2, ASA physical status Ⅱ or Ⅲ, were randomly divided into four groups: dexmedetomidine combined with esketamine group (group DE), esketamine group (group E), dexmedetomidine group (group D), and control group (group C), 34 patients in each group. In groups DE and D, a loading dose of dexmedetomidine 0.5 μg/kg was infused intravenously over 10 minutes before induction, followed by a continuous infusion of 0.4 μg·kg-1·h-1 until 40 minutes before the end of surgery. In groups DE and E, a loading dose of esketamine 0.5 mg/kg was injected intravenously at induction, followed by a continuous infusion of 0.1 mg·kg-1·h-1 until 40 minutes before the end of surgery. Equal volumes of normal saline were given to group C at the same time points. The 40-item quality of recovery scores (QoR-40) 24 hours before surgery and 24 hours after surgery were recorded. The dosage of intraoperative propofol and remifentanil, the dosage of dezocine within 24 hours after surgery, extubation time after surgery, the time of first getting out of bed and the time of first anal exhaust after surgery were recorded. The resting visual analogue scale (VAS) pain scores were recorded at the moment of extubation, 2, 6, 12, and 24 hours after surgery. The occurrence of postoperative adverse reactions such as nausea and vomiting, agitation, hypoxemia, and pneumonia were recorded.
Results: Compared with group C, the QoR-40 scores in groups DE, E, and D were significantly increased 24 hours after surgery (P < 0.05), the dosage of intraoperative propofol and remifentanil, the dosage of dezocine within 24 hours after surgery were significantly reduced, the time of first getting out of bed and the time of first anal exhaust after surgery were significantly shortened in group DE (P < 0.05), the resting VAS pain scores at the moment of extubation, 2, 6, and 12 hours after surgery were significantly decreased in groups DE and E (P < 0.05), the resting VAS pain scores at the moment of extubation and 2 hours after surgery were significantly decreased in group D (P < 0.05). Compared with group D, the QoR-40 scores were significantly increased 24 hours after surgery, the dosage of intraoperative propofol was significantly reduced, and the resting VAS pain scores 2, 6,and 12 hours after surgery were significantly decreased in group DE (P < 0.05). Compared with group E, the QoR-40 scores were significantly increased 24 hours after surgery, the dosage of intraoperative propofol was significantly reduced, and the resting VAS pain scores 2, 6 hours after surgery were significantly decreased in group DE (P < 0.05). There were no statistically differences in resting VAS pain scores 24 hours after surgery, and the occurrence of postoperative adverse reactions among the four groups.
Conclusion: Dexmedetomidine combined with esketamine relieves postoperative pain, enhances the quality of postoperative recovery, and promotes rapid rehabilitation in patients undergoing laparoscopic gastric volume reduction surgery. |
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