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| 连续输注艾司氯胺酮对机器人辅助前列腺癌根治术老年衰弱患者术后胃肠功能的影响 |
| Effects of continuous infusion of esketamine on postoperative gastrointestinal function in aged frail patients undergoing robot-assisted radical prostatectomy |
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| DOI：10.12089/jca.2026.02.003 |
| 中文关键词: 艾司氯胺酮 机器人辅助前列腺癌根治术 术后胃肠道功能障碍 老年 衰弱 |
| 英文关键词: Esketamine Robot-assisted radical prostatectomy Postoperative gastrointestinal dysfunction Aged Frailty |
| 基金项目:新疆维吾尔自治区自然科学基金（2024D01C287）；新疆维吾尔自治区人民医院院内项目（20230105）；新疆维吾尔自治区重点研发计划项目（2022B03009-4） |
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| 中文摘要: |
目的：探讨连续输注艾司氯胺酮对机器人辅助前列腺癌根治术（RARP）老年衰弱患者术后胃肠功能的影响。
方法：选择全身麻醉下行RARP的老年衰弱患者，年龄65～85岁，ASA Ⅱ或Ⅲ级。采用随机数字表法分为三组：艾司氯胺酮0.125 mg·kg-1·h-1组（E1组）、艾司氯胺酮0.25 mg·kg-1·h-1组（E2组）和对照组（C组）。麻醉诱导后即刻，E1组连续输注艾司氯胺酮0.125 mg·kg-1·h-1，E2组连续输注艾司氯胺酮0.25 mg·kg-1·h-1，C组则以相同速率输注等容量生理盐水。主要指标为术后首次肛门排气时间。次要指标包括术后首次排便时间、进食-恶心-呕吐-查体-症状持续时间（I-FEED）评分，术中丙泊酚、瑞芬太尼用量，麻醉诱导前和术后1 d肠道脂肪酸结合蛋白（I-FABP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）浓度，术后24、48 h静息和活动时NRS疼痛评分，术后48 h内自控镇痛次数。不良反应包括围术期高血压、低血压、心动过缓、心动过速、苏醒期躁动和术后恶心呕吐（PONV）。
结果：共纳入患者93例，每组31例。与C组比较，E1组和E2组术后首次肛门排气时间和首次排便时间明显缩短，I-FEED评分、术后1 d I-FABP、IL-6和TNF-α浓度明显降低，术中瑞芬太尼用量和自控镇痛次数明显减少，低血压发生率明显降低（P＜0.05）。与E2组比较，E1组术中瑞芬太尼用量明显增加（P＜0.05），术后1 d IL-6和TNF-α浓度明显升高（P＜0.05）。
结论：在RARP中连续输注艾司氯胺酮0.125与0.25 mg·kg-1·h-1可有效促进老年衰弱患者术后胃肠功能恢复，其中0.25 mg·kg-1·h-1剂量在协同镇痛和抗炎方面更具优势，为老年衰弱患者围术期麻醉管理提供了新的参考。 |
| 英文摘要: |
Objective: To investigate the effects of continuous infusion of esketamine on postoperative gastrointestinal function in aged frail patients undergoing robot-assisted radical prostatectomy (RARP).
Methods: Aged frail patients scheduled for RARP under general anesthesia were enrolled, aged 65-85 years with ASA physical status Ⅱ or Ⅲ. They were randomly assigned to three groups using a random number table: the esketamine 0.125 mg·kg-1·h-1 group (group E1), the esketamine 0.25 mg·kg-1·h-1 group (group E2), and the control group (group C). Continuous infusion of the study drug was initiated immediately after anesthesia induction: esketamine 0.125 mg·kg-1·h-1 in group E1, esketamine 0.25 mg·kg-1·h-1 in group E2, and an equivalent volume of normal saline at the same rate in group C. The primary outcome was the time to first postoperative flatus. Secondary outcomes included time to first defecation, the intake, feeling nauseated, emesis, exam and duration of symptoms scoring system (I-FEED) score, intestinal fatty acid binding protein (I-FABP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) before anesthesia induction and on postoperative day 1, resting and activity numerical rating scale (NRS) pain scores at 24 and 48 hours postoperatively, the number of patient-controlled analgesia deliveries within 48 hours. Adverse reactions included perioperative adverse events such as hypertension, hypotension, bradycardia, tachycardia, emergence agitation, and postoperative nausea and vomiting (PONV).
Results: A total of 93 patients were enrolled, with 31 in each group. Compared with group C, both group E1 and group E2 demonstrated significantly shorter time to first flatusand first defecation, lower I-FEED scores,reduced plasma concentrations of I-FABP, IL-6, and TNF-α on postoperative day 1, decreased intraoperative remifentanil consumption and number of patient-controlled analgesia deliveries, and a lower incidence of hypotension (P < 0.05). Furthermore, compared with group E2, group E1 showed significantly higher intraoperative remifentanil consumption and elevated postoperative levels of IL-6 and TNF-α (P < 0.05).
Conclusion: Continuous infusion of esketamine at doses of 0.125 and 0.25 mg·kg-1·h-1 during RARP effectively promotes the recovery of postoperative gastrointestinal function in aged frail patients. The 0.25 mg·kg-1·h-1 dose demonstrates superior advantages in synergistic analgesia and anti-inflammatory effects, providing a valuable reference for perioperative anesthetic management in this patient population. |
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