亚麻醉剂量艾司氯胺酮对老年腹腔镜结直肠癌根治术患者肺动态顺应性及氧合指数的影响

The effects of sub-anesthetic doses of esketamine on pulmonary dynamic compliance and oxygenation index in elderly patients undergoing laparoscopic radical resection for colorectal cancer

摘要:

目的 探讨亚麻醉剂量艾司氯胺酮对老年腹腔镜结直肠癌根治术患者肺动态顺应性（Cdyn）及氧合指数（OI）的影响。方法 选取2021年5月—2023年7月在沧州市人民医院行腹腔镜结直肠癌根治术的108例老年患者。随机将患者分为对照组和研究组，每组54例，对照组使用常规麻醉，研究组在常规麻醉基础上加用亚麻醉剂量艾司氯胺酮。比较两组麻醉诱导前（T₀）、气管插管后10 min（T₁）、二氧化碳气腹+头低足高位1 h（T₂）、手术结束时（T₃）的心率、收缩压、舒张压、脑电双频指数（BIS）、氧合指数及Cdyn；记录患者镇痛情况、认知功能及镇痛泵使用情况及气道相关不良事件发生情况。结果 两组患者T₀、T₁、T₂、T₃时的心率、收缩压、舒张压、BIS比较，结果 ①不同时间点心率、收缩压、舒张压和BIS比较，差异均有统计学意义（F =14.193、83.539、49.394和71.834，均P <0.05）；②两组患者心率、收缩压、舒张压和BIS比较，差异均有统计学意义（F =55.721、37.482、55.283和38.947，均P <0.05）；③两组患者心率、收缩压、舒张压和BIS变化趋势比较，差异均有统计学意义（F =9.821、16.372、18.482和22.941，均P <0.05）。两组患者T₀、T₁、T₂、T₃时的OI、Cdyn比较，结果 ①不同时间点OI、Cdyn比较，差异均有统计学意义（F =66.937和99.485，均P <0.05）；②两组患者OI、Cdyn比较，差异均有统计学意义（F =92.481和147.935，均P <0.05）；③两组患者OI、Cdyn变化趋势比较，差异均有统计学意义（F =38.481和59.395，均P <0.05）。研究组定向力恢复时间、拔管时间和苏醒时间均短于对照组（P <0.05）。两组患者住院时间比较，差异无统计学意义（P >0.05）。两组患者术后30 min、2 h、12 h、24 h静息状态下VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（F =3.731，P <0.05）；②两组患者VAS评分比较，差异有统计学意义（F =6.982，P <0.05），研究组较对照组低，相对镇痛效果较好；③两组患者VAS评分变化趋势比较，差异有统计学意义（F =18.634，P <0.05）。两组患者术前、术后12 h、24 h、2 d的MMSE评分比较，结果 ①不同时间点MMSE评分比较，差异有统计学意义（F =5.692，P <0.05）；②两组患者MMSE评分比较，差异有统计学意义（F =3.560，P <0.05），研究组术后较对照组高，相对认知功能恢复较好；③两组患者MMSE评分变化趋势比较，差异有统计学意义（F =7.953，P <0.05）。研究组术后48 h内有效按压次数、无效按压次数和总按压次数均少于对照组（P <0.05）。两组患者不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 亚麻醉剂量的艾司氯胺酮在老年腹腔镜结直肠癌根治术患者中使用能提高Cdyn和OI，有助于加快术后恢复，改善疼痛管理，并有助于认知功能的快速恢复。

Abstract:

Objective To explore the effects of sub-anesthetic doses of esketamine on pulmonary dynamic compliance (Cdyn) and oxygenation index (OI) in elderly patients undergoing laparoscopic radical surgery for colorectal cancer.Methods From May 2021 to July 2023, a total of 108 elderly patients undergoing laparoscopic radical resection for colorectal cancer in Cangzhou People's Hospital were selected. They were randomly assigned to the control group and the study group, each comprising 54 participants. The control group received standard anesthesia, while the study group additionally received a sub-anesthetic dose of esketamine. The systolic blood pressure, diastolic blood pressure, bispectral index (BIS), OI, and pulmonary Cdyn before anesthesia induction (T₀), 10 minutes after tracheal intubation (T₁), one hour after initiating CO₂ pneumoperitoneum in the Trendelenburg position (T₂), and at the end of surgery (T₃) were compared between the two groups. The analgesic status, cognitive function, analgesic pump usage and the incidence of airway-related adverse events were recorded.Results The heart rate, systolic blood pressure, diastolic blood pressure, and BIS at T₀, T₁, T₂, and T₃ in the two groups were compared via repeated measures analysis of variance, and the results showed that they were different among the time points (F =14.193, 83.539, 49.394 and 71.834, all P < 0.05) and between the groups (F =55.721, 37.482, 55.283 and 38.947, all P < 0.05), and that the change trends of them were different between the groups (F =9.821, 16.372, 18.482 and 22.941, all P < 0.05). The OI and pulmonary Cdyn at T₀, T₁, T₂, and T₃ in the two groups were compared via repeated measures analysis of variance, and the results demonstrated that they were different among the time points (F =66.937 and 99.485, both P < 0.05) and between the groups (F =92.481 and 147.935, both P < 0.05), and that the change trends of them were different between the groups (F =38.481 and 59.395, both P < 0.05). The time to recovery of orientation, extubation time, and awakening time in the study group were shorter than those in the control group (P < 0.05). There was no difference in the length of hospital stay between the two groups of patients (P > 0.05). Comparison of VAS scores at rest between the study group and the control group 30 minutes, 2 hours, 12 hours, and 24 hours after surgery via repeated measures analysis of variance revealed that the VAS scores were different among the time points (F =3.731, P < 0.05) and between the groups (F = 6.982, P < 0.05), where the VAS scores in the study group were higher than those in the control group, indicating better anesthetic effects in the study group. Besides, the change trends of VAS scores were also different between the two groups (F = 18.634, P < 0.05). The comparison of MMSE scores between the study group and the control group before surgery and 12 hours, 24 hours, and 2 days after surgery via repeated measures analysis of variance exhibited that they were different among the time points (F = 5.692, P < 0.05) and between the groups (F = 3.560, P < 0.05). The study group had higher postoperative MMSE scores and better recovery of relative cognitive function compared with the control group. The change trends of MMSE scores were also different between the two groups (F = 7.953, P < 0.05). The numbers of effective presses, ineffective presses, and total presses of the analgesic pump within 48 hours postoperatively were all lower in the study group compared with the control group (P < 0.05). There was no statistically significant difference in the overall incidence of adverse events between the two groups (P > 0.05).Conclusions Sub-anesthetic doses of esketamine significantly improves pulmonary Cdyn and OI in elderly patients undergoing laparoscopic radical resection for colorectal cancer, accelerating postoperative recovery, enhancing pain management, and facilitating the rapid recovery of cognitive function.