文章摘要
术中持续输注艾司氯胺酮对老年患者腹腔镜胆囊切除术后恢复质量的影响
Effect of intraoperative continuous esketamine infusion on postoperative recovery quality in elderly patients undergoing laparoscopic cholecystectomy
  
DOI：10.12089/jca.2025.09.007
中文关键词: 老年  麻醉维持  艾司氯胺酮  腹腔镜胆囊切除术  术后恢复质量
英文关键词: Aged  Anesthesia maintenance  Esketamine  Laparoscopic cholecystectomy  Postoperative recovery quality
基金项目:浦东新区高峰高原学科建设临床医学新质专科(专病)项目(2024-PWXZ-02)
作者单位E-mail
夏汇 200120,上海市,同济大学附属东方医院麻醉科  
梁涛 200120,上海市,同济大学附属东方医院麻醉科  
苏丹 200120,上海市,同济大学附属东方医院麻醉科  
王祥瑞 200120,上海市,同济大学附属东方医院麻醉科  
杨隆秋 200120,上海市,同济大学附属东方医院麻醉科 yanglongqiu2024@163.com 
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中文摘要:
      
目的：探究术中持续输注艾司氯胺酮对老年患者腹腔镜胆囊切除术后恢复质量的影响。
方法：选择择期行全麻腹腔镜胆囊切除术的老年患者228例，男132例，女96例，年龄65～84岁，BMI 18.5～30.0 kg/m2，ASA Ⅱ或Ⅲ级。将患者随机分为两组：艾司氯胺酮组（E组）和对照组（C组），每组114例。 E组在切皮前5 min给予艾司氯胺酮0.4 mg/kg，然后予以艾司氯胺酮0.4 mg·kg-1·h-1持续输注直至切口缝合完毕前5 min。C组给予等量生理盐水。记录术后1、2和3 d的15项恢复质量（QoR-15）评分。记录术中输注瑞芬太尼用量和术后补救镇痛例数，术后2 d匹兹堡睡眠质量指数（PSQI），术后1、6 h、1、2和3 d的VAS疼痛评分。记录低血压、恶心呕吐、嗜睡、谵妄等不良事件的发生情况。
结果：与C组比较，E组术后1、2和3 d的QoR-15评分明显升高（P< 0.05），但差异未达到最小临床意义差值，术中瑞芬太尼用量明显减少（P<0.05），术后补救镇痛率明显降低（P<0.05），术后2 d PSQI评分明显降低（P<0.05），术后1 h和术后1 d VAS疼痛评分明显降低（P<0.05）。两组术后不良事件发生率差异无统计学意义。
结论：术中持续输注艾司氯胺酮能够改善老年患者腹腔镜胆囊切除术后恢复质量，但改善幅度不足以达到患者可感知的水平，因此该方案的临床价值仍需进一步验证。此外，术中持续输注艾司氯胺酮改善了术后睡眠质量，有助于围术期疼痛管理，且没有增加术后不良事件的发生率。
英文摘要:
      
Objective: To investigate the effect of intraoperative continuous infusion of esketamine on postoperative recovery quality in elderly patients undergoing laparoscopic cholecystectomy.
Methods: A total of 228 elderly patients scheduled to undergo elective laparoscopic cholecystectomy were selected, comprising 132 males and 96 females, aged 65-84 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅱ or Ⅲ. The patients were randomly divided into two groups: the esketamine group (group E) and the control group (group C), 114 patients in each group. Group E received a bolus of esketamine 0.4 mg/kg 5 minutes before skin incision, followed by a continuous infusion of esketamine 0.4 mg·kg-1·h-1 until 5 minutes before the completion of skin closure. Group C received an equivalent volume of normal saline. The remaining protocols were identical for both groups. The quality of recovery-15 (QoR-15) scale was recorded on postoperative days 1, 2, and 3. The total intraoperative remifentanil consumption and the number of patients requiring rescue analgesia were recorded. The Pittsburgh sleep quality index (PSQI) was assessed on postoperative day 2. Visual analog scale (VAS) pain scores were recorded at 1 hour, 6 hours postoperatively, and on postoperative days 1, 2, and 3. The occurrence of adverse events including hypotension, nausea and vomiting, drowsiness, and delirium was documented.
Results: Compared with group C, group E showed significantly higher QoR-15 scores on postoperative days 1, 2, and 3 (P < 0.05), although the difference did not reach the minimal clinically important difference, significantly reduced intraoperative remifentanil consumption (P < 0.05), significantly fewer patients requiring rescue analgesia postoperatively (P < 0.05), significantly lower PSQI scores on postoperative days 2 (P < 0.05) and significantly lower VAS pain scores at 1 hour postoperatively and on postoperative day 1 (P < 0.05).There was no significant difference in the incidence of postoperative adverse events between the two groups.
Conclusion: Continuous intraoperative infusion of esketamine improved the quality of recovery in elderly patients following laparoscopic cholecystectomy. However, the magnitude of improvement was insufficient to reach a patient-perceptible level. Consequently, the clinical value of this regimen requires further validation. Additionally, esketamine infusion enhanced postoperative sleep quality, contributed to perioperative pain management, and did not increase the incidence of adverse events.
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