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| 亚麻醉剂量艾司氯胺酮对老年患者腹腔镜结直肠癌根治术后恢复质量的影响 |
| Effect of subanesthetic doses esketamine on the quality of recovery in elderly patients undergoing laparoscopic colorectal cancer surgery |
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| DOI：10.12089/jca.2026.06.004 |
| 中文关键词: 艾司氯胺酮 结直肠癌根治术 恢复质量 老年 |
| 英文关键词: Esketamine Colorectal cancer surgery Quality of recovery Aged |
| 基金项目:江苏省卫生健康委医学科研项目（X20241377）；镇江市“金山英才”医学领域高层次人才创新团队计划（JSYCTD202401）；镇江市社会发展面上项目（SH2024017） |
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| 中文摘要: |
目的：评价基于亚麻醉剂量艾司氯胺酮的低阿片化麻醉策略对老年患者腹腔镜结直肠癌根治术后恢复质量的影响。
方法：选择择期行腹腔镜结直肠癌根治术的老年患者，年龄65～85岁，BMI 18.5～28.0 kg/m2，ASA Ⅱ或Ⅲ级。将患者随机分为两组：艾司氯胺酮组（S组）和对照组（C组）。麻醉诱导：C组给予瑞马唑仑0.15 mg/kg、丙泊酚1.0 mg/kg、舒芬太尼0.5 μg/kg和罗库溴铵0.9 mg/kg；S组给予舒芬太尼0.25 μg/kg、艾司氯胺酮0.25 mg/kg，其余诱导药物同C组。在切皮前C组给予舒芬太尼0.1 μg/kg，S组给予艾司氯胺酮0.3 mg/kg。麻醉维持：两组均静脉泵注瑞芬太尼0.1～0.3 μg·kg·-1min-1、右美托咪定0.4 μg·kg·-1h-1和丙泊酚靶控输注，S组同时泵注艾司氯胺酮0.12 mg·kg·-1h-1。主要指标为术后1 d 15项恢复质量量表（QoR-15）评分。次要指标包括术前1 d及术后2、3 d QoR-15评分、术前及术后1、2、3 d阿森斯失眠量表（AIS）评分和外周静脉血中白细胞介素-6（IL-6）、C-反应蛋白（CRP）、神经元特异性烯醇化酶（NSE）浓度，术前24 h、出PACU时、术后6、12、24、48 h活动时NRS疼痛评分，术后72 h内镇痛泵有效按压次数、总按压次数和补救镇痛情况、术后首次下床活动时间和术后首次肛门排气时间。不良反应包括谵妄、头晕、恶心呕吐、瘙痒等。
结果：本研究共纳入患者94例，每组47例。与C组比较，S组术后1、2、3 d QoR-15评分明显升高，术后12、24 h活动时NRS评分及术后1、2、3 d AIS评分明显降低，术后1、3 d IL-6水平明显降低，术后首次下床及肛门排气时间明显缩短（P＜0.05）。两组术后不良反应发生率差异无统计学意义。
结论： 在腹腔镜结直肠癌根治术中，使用亚麻醉剂量艾司氯胺酮可显著提高老年患者术后早期恢复质量，改善睡眠质量，减轻术后疼痛，且不增加不良反应。 |
| 英文摘要: |
Objective: To evaluate the effect of a low-opioid anesthesia strategy based on subanesthetic dose of esketamine on the quality of postoperative recovery in elderly patients undergoing laparoscopic radical colorectal cancer surgery.
Methods: Patients undergoing laparoscopic radical colorectal cancer surgery, aged 65-85 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅱ or Ⅲ, were selected and randomly divided into two groups: esketamine group (group S) and control group (group C). Anesthesia induction: group C received remimazolam 0.15 mg/kg, propofol 1.0 mg/kg, sufentanil 0.5 μg/kg, and rocuronium 0.9 mg/kg, group S received sufentanil 0.25 μg/kg plus esketamine 0.25 mg/kg, with other drugs identical to C. Before skin incision, group C was given sufentanil 0.1 μg/kg, and group S was given esketamine 0.3 mg/kg. Anesthesia maintenance: both groups received continuous intravenous infusion of remifentanil 0.1-0.3 μg·kg·-1min-1, dexmedetomidine 0.4 μg·kg·-1h-1, and target-controlled infusion of propofol, group S additionally received esketamine 0.12 mg·kg·-1h-1. The primary outcome was the quality of recovery-15 (QoR-15) score on postoperative day 1. Secondary outcomes included QoR-15 scores on the day before surgery and on postoperative days 2 and 3, preoperative and postoperative days 1 to 3 Athens insomnia scale (AIS) scores and levels of interleukin-6 (IL-6), C-reactive protein (CRP), and neuron-specific enolase (NSE) in peripheral venous blood were measured. NRS pain scores during activity were recorded at 24 hours before surgery, upon leaving the PACU, and at 6, 12, 24, and 48 hours postoperatively. The effective presses, total number of presses of the analgesic pump, and use of rescue analgesia within 72 hours postoperatively, time to first ambulation after surgery, and time to first flatus were recorded. The occurrence of adverse events included delirium, dizziness, nausea and vomiting, and itching.
Results: Ninety-four patients were ultimately included in this study, with 47 patients in each group. Compared with group C, group S showed significantly higher QoR-15 scores on postoperative days 1 to 3, significantly lower NRS scores during activity at 12 and 24 hours postoperatively and lower AIS scores on postoperative days 1 to 3, significantly lower IL-6 levels on postoperative days 1 and 3, and shorter time to first ambulation and first flatus (P < 0.05). There was no significant difference in the incidence of postoperative adverse events between the two groups.
Conclusion: In elderly patients undergoing laparoscopic radical colorectal cancer surgery, subanesthetic-dose esketamine significantly improved postoperative recovery quality, enhanced sleep, and reduced postoperative pain without increasing adverse events. |
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