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| 术前应用艾司氯胺酮联合腹横肌平面阻滞对腹腔镜胆囊切除术后疲劳与情绪的影响 |
| Effect of preoperative administration of esketamine combined with transversus abdominis plane block on postoperative fatigue and mood in patients undergoing laparoscopic cholecystectomy |
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| DOI：10.12089/jca.2026.05.003 |
| 中文关键词: 腹横肌平面阻滞 艾司氯胺酮 腹腔镜胆囊切除术 疲劳 情绪 |
| 英文关键词: Transversus abdominis plane block Esketamine Laparoscopic cholecystectomy Fatigue Mood |
| 基金项目:苏州市科技计划项目（SKY2022195） |
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| 中文摘要: |
目的：探究术前应用艾司氯胺酮联合腹横肌平面阻滞（TAPB）对腹腔镜胆囊切除术（LC）患者术后疲劳（POF）与情绪的影响。
方法：选择2021年3月至2023年11月行LC的患者，年龄18～64岁，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：联合组与对照组。联合组于麻醉诱导时静注艾司氯胺酮0.125 mg/kg，于麻醉诱导后、手术开始前行TAPB；对照组仅行单纯全身麻醉。主要指标为术后24 h疲劳测评量表（ICFS）评分。次要指标包括术后48、72 h ICFS评分，术前24 h和术后24 h抑郁自评量表（SDS）评分和焦虑自评量表（SAS）评分，术后2、24 h血清脑源性神经营养因子（BDNF）浓度，镇痛泵总按压次数、镇痛泵有效按压次数、补救镇痛率，苏醒时间、自主呼吸恢复时间、拔管时间、术后首次肛门排气时间、术后首次进食时间。不良反应包括术后48 h内恶心呕吐、呼吸抑制、头晕头痛、穿刺位置感染、窦性心动过速、术后谵妄等。
结果：共纳入患者152例，每组76例。与对照组比较，联合组术后24、48、72 h ICFS的疲劳感、活力感、疲劳对精力的影响、疲劳对注意力的影响、疲劳对日常活动的影响和总分均明显降低，术后24 h SDS评分和SAS评分明显降低，术后2、24 h血清BDNF浓度明显升高，镇痛泵总按压次数和镇痛泵有效按压次数明显减少，补救镇痛率明显降低，苏醒时间、自主呼吸恢复时间、拔管时间、术后首次肛门排气时间和术后首次进食时间明显缩短，恶心呕吐发生率明显降低（P<0.05）。
结论：术前应用艾司氯胺酮联合TAPB能够减轻LC患者POF程度和不良情绪，同时提升术后血清BDNF浓度，改善术后恢复质量。 |
| 英文摘要: |
Objective: To investigate the effect of preoperative administration of esketamine combined with transversus abdominis plane block (TAPB) on postoperative fatigue (POF) and mood in patients undergoing laparoscopic cholecystectomy (LC).
Methods: Patients who underwent LC from March 2021 to November 2023 were selected, aged 18-64 years, ASA physical status Ⅰ or Ⅱ. The patients were divided into two groups by random number table method: combined group and control group. The control group received general anesthesia alone, while the combined group, on the basis of the control group, was combined with esketamine 0.125 mg/kg during anesthesia induction and TAPB after anesthesia induction and before the start of the surgery. The primary outcome was the identify-consequence fatigue scale (ICFS) score at 24 hours postoperatively. Secondary outcomes included the ICFS scores at 48 and 72 hours postoperatively, the self-rating depression scale (SDS) scores and the self-rating anxiety scale (SAS) scores at 24 hours preoperatively and 24 hours postoperatively. The concentration of serum brain-derived neurotrophic factor (BDNF) at 2 and 24 hours postoperatively, the total pressing times of the analgesic pump, the effective pressing times of the analgesic pump, the rate of remedial analgesia, the awakening time, the recovery time of spontaneous breathing, the extubation time, the time of the first anal exhaust after surgery, and the time of the first meal after surgery. Adverse reactions included nausea and vomiting, respiratory depression, dizziness and headache, infection at the puncture site, sinus tachycardia, and postoperative delirium within 48 hours postoperatively.
Results: A total of 152 patients were enrolled, 76 patients in each group. Compared with the control group, the fatigue sensation, the vitality sensation, the impact of fatigue on energy, the impact of fatigue on attention, the impact of fatigue on daily life, and the total score of ICFS in the combined group were significantly decreased at 24, 48, and 72 hours postoperatively, the SDS score and SAS score at 24 hours postoperatively were significantly decreased, the BDNF concentration at 2 and 24 hours postoperatively was significantly increased, the total pressing times of the analgesic pump, the effective pressing times of the analgesic pump, and the rate of rescue analgesia were significantly reduced, the awakening time, the recovery time of spontaneous breathing, the extubation time, the time of the first postoperative anal exhaust and the time of the first postoperative meal were significantly shortened, and the incidence of nausea and vomiting was significantly decreased (P < 0.05).
Conclusion: Preoperative administration of esketamine combined with TAPB can reduce the postoperative fatigue and negative emotions of patients with laparoscopic LC, increase the serum BDNF concentration at the same time, improve postoperative recovery. |
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