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| 艾司氯胺酮联合右美托咪定对环状脱垂痔切除术患者术后睡眠和恢复质量的影响 |
| Effects of esketamine combined with dexmedetomidine on postoperative sleep and recovery quality in patients undergoing circumferential prolapsed hemorrhoidectomy |
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| DOI：10.12089/jca.2024.12.002 |
| 中文关键词: 艾司氯胺酮 右美托咪定 环状脱垂痔切除术 恢复质量 睡眠质量 |
| 英文关键词: Esketamine Dexmedetomidine Circular prolapsed hemorrhoidectomy Recovery quality Sleep quality |
| 基金项目:河南省医学教育研究项目（WJLX2024056，Wjlx2022060）；河南省医学科技攻关计划软科学项目（RKX202202026）；河南省卫生系统出国研修项目计划（2016021）；郑州大学教改项目（2024ZZUJGXM235）；郑州大学研究生教育研究重点项目（YJSJY202115） |
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| 中文摘要: |
目的：观察艾司氯胺酮联合右美托咪定对环状脱垂痔切除术患者术后睡眠和恢复质量的影响。
方法：选择择期行环状脱垂痔切除术患者60例，男33例，女27例，年龄18～64岁，BMI 18.5～30.0 kg/m 2，ASA Ⅰ或Ⅱ级。根据随机数字表法将患者分为两组：艾司氯胺酮联合右美托咪定组（F组）和阿片类药物麻醉组（A组），每组30例。F组麻醉诱导前输注右美托咪定0.6 μg/kg，诱导时给予艾司氯胺酮0.5 mg/kg，术中持续泵注右美托咪定0.3 μg·kg-1·h-1和艾司氯胺酮0.25 mg·kg-1·h-1。A组麻醉诱导前接受等体积生理盐水，诱导时给予舒芬太尼0.5 μg/kg，术中持续泵注环泊酚0.4 mg·kg-1·h-1和瑞芬太尼0.1~0.4 μg·kg-1·min-1。记录手术持续时间、拔管时间、PACU停留时间。术前1 d和术后1 d采用15项恢复质量（QoR-15）量表评估患者状态，阿森斯失眠量表（AIS）和数字评价量表（NRS）评估睡眠情况。记录术毕即刻、术后2、6、12、24 h VAS疼痛评分，术后恶心呕吐、头晕、口腔分泌物增多、呼吸抑制、排尿困难等围术期不良反应的发生情况。
结果：与A组比较，F组拔管时间、PACU停留时间明显延长，术后1 d QoR-15评分明显升高、AIS和NRS评分明显降低，术后恶心、排尿困难发生率明显降低（P＜0.05），两组手术持续时间、术后不同时点VAS疼痛评分，头晕、口腔分泌物增多和呼吸抑制等围术期不良反应发生率差异无统计学意义。
结论：艾司氯胺酮联合右美托咪定能够改善环状脱垂痔切除术患者术后睡眠和恢复质量，减少术后恶心、排尿困难的发生。 |
| 英文摘要: |
Objective: To observe the impact of esketamine combined with dexmedetomidine on postoperative sleep and recovery quality in patients undergoing circumferential prolapsed hemorrhoidectomy.
Methods: Sixty patients undergoing elective circular prolapsed hemorrhoidectomy, including 33 males and 27 females, aged 18-64 years, BMI 18.5-30.0 kg/m 2, ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups using the random number table method: the esketamine combined with dexmedetomidine group (group F) and the opioid anesthesia group (group A), 30 patients in each group. In group F, dexmedetomidine was infused at 0.6 μg/kg before anesthesia induction, and esketamine was given at 0.5 mg/kg during induction, with continuous infusion of dexmedetomidine 0.3 μg·kg-1·h-1 and esketamine 0.25 mg·kg-1·h-1 during surgery. In group A, an equal volume of physiological saline was given before induction, sufentanil was given at 0.5 μg/kg during induction, and continuous infusion of ciprofol 0.4 mg·kg-1·h-1 and remifentanil 0.1-0.4 μg·kg-1·min-1 was maintained during surgery. The duration of surgery, extubation time, and PACU stay time were recorded. The patients' conditions were assessed using the 15-item quality of recovery (QoR-15) scale, sleep quality was evaluated using the Athens insomnia scale (AIS), and pain was assessed using the numeric rating scale (NRS). The VAS pain scores were recorded immediately after the operation, and at 2, 6, 12, and 24 hours postoperatively; and record the incidence of perioperative adverse reactions, including nausea and vomiting, dizziness, increased oral secretions,respiratory depression and difficulty urinating.
Results: Compared with group A, Group F had significantly longer extubation times and PACU stay time, with significantly higher QoR-15 scores and significantly lower AIS and NRS scores on the first postoperative day. The incidence of postoperative nausea and difficulty urinating was reduced considerably (P < 0.05). There were no statistically significant differences in operation time, VAS pain scores, and the incidence of perioperative adverse reactions like dizziness, increased oral secretions, and respiratory depression between the two groups.
Conclusion: Esketamine combined with dexmedetomidine can improve postoperative sleep and recovery quality for patients undergoing circumferential prolapsed hemorrhoidectomy, and reduce the incidence of postoperative nausea and difficulty urinating. |
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