艾司氯胺酮复合右美托咪定联合腹横肌平面阻滞对妇科腹腔镜术后恶心呕吐的影响

The effect of esketamine combined with dexmedetomidine and transversus abdominis plane block on postoperative nausea and vomiting after gynecological laparoscopy

摘要:

目的 探讨艾司氯胺酮复合右美托咪定联合腹横肌平面阻滞对妇科腹腔镜术后恶心呕吐的影响。方法 回顾性分析2021年7月—2023年7月在西北大学第一医院接受妇科腹腔镜治疗的98例患者的病历资料，根据麻醉方案分为观察组52例和对照组46例。两组全身麻醉前行下腹横纹肌平面阻滞；对照组术中采用丙泊酚复合瑞芬太尼麻醉（阿片麻醉），观察组术中采用艾司氯胺酮复合右美托咪定麻醉（无阿片麻醉）。比较两组的手术指标、术后恶心呕吐、术后镇静/躁动、术后疼痛及并发症的发生情况。结果 观察组术后自主呼吸恢复时间、苏醒时间和拔管时间均短于对照组（P <0.05）。观察组与对照组手术时间和气腹建立时间比较，差异均无统计学意义（P >0.05）。两组气腹建立、气腹建立15 min、气腹建立30 min的HR及SpO₂比较，结果 ①不同时间点的HR及SpO₂比较，差异无统计学意义（F =1.416，P =0.103；F =2.031，P =0.079）；②两组HR及SpO₂的比较，差异无统计学意义（F =0.715，P =0.683；F =1.069，P =0.341）；③两组HR及SpO₂的变化趋势比较，差异无统计学意义（F =2.018，P =0.080；F =2.815，P =0.072）。观察组术后恶心呕吐等级低于对照组（Z =8.478，P =0.037），补救次数少于对照组（Z =3.071，P =0.003）。观察组Ramsay评分低于对照组（P <0.05），Ricker镇静-躁动评分高于对照组（P <0.05）。观察组术后2 h、术后12 h的疼痛程度评分均低于对照组（P <0.05）；两组术后镇痛补救次数比较，差异无统计学意义（P >0.05）。观察组与对照组心动过缓发生率、低血压率、术后乏力发生率和便秘率的比较，差异均无统计学意义（P >0.05）。结论 妇科腹腔镜麻醉术中应用艾司氯胺酮复合右美托咪定联合腹横肌平面阻滞，有助于减轻术后疼痛，减少术后恶心呕吐的发生。

Abstract:

Objective To investigate the effect of esketamine combined with dexmedetomidine and transversus abdominis plane (TAP) block on postoperative nausea and vomiting (PONV) after gynecological laparoscopy.Methods A retrospective analysis was conducted on the medical records of 98 patients who underwent gynecological laparoscopy at The First Hospital of Northwest University from July 2021 to July 2023. According to the anesthesia plan, the patients were divided into an observation group (52 cases) and a control group (46 cases). Both groups underwent TAP block before general anesthesia. The control group received propofol combined with remifentanil anesthesia (opioid anesthesia), while the observation group received esketamine combined with dexmedetomidine anesthesia (non-opioid anesthesia). Surgical indicators, postoperative nausea and vomiting, postoperative sedation/agitation, postoperative pain, and complications were compared between the two groups.Results The observation group had shorter recovery time for spontaneous breathing, awakening time, and extubation time compared to the control group (P < 0.05). There were no significant differences between the two groups in terms of surgery duration and pneumoperitoneum establishment time (P > 0.05). The comparison of HR and SpO₂ between two groups of pneumoperitoneum establishment, 15 min pneumoperitoneum establishment, and 30 min pneumoperitoneum establishment was conducted using a repeated measures design analysis of variance. The results showed that: (1) There was no statistically significant difference in HR and SpO₂ between different time points (F =1.416, P =0.103; F =2.031, P =0.079). (2) There was no statistically significant difference in HR and SpO₂ between the two groups (F =0.715, P =0.683; F =1.069, P =0.341). (3) There was no statistically significant difference in HR and SpO₂ between the two groups (F =2.018, P =0.080；F =2.815，P =0.072）. The observation group had lower postoperative nausea and vomiting levels compared to the control group (Z =8.478, P =0.037) and fewer rescue doses (Z =3.071, P =0.003). Ramsay sedation scores in the observation group were lower than in the control group (P < 0.05), while Ricker agitation-sedation scores were higher in the observation group (P < 0.05). The observation group had lower pain scores at 2 hours and 12 hours postoperatively (P < 0.05), with no significant difference in the number of pain rescue doses between the two groups (P > 0.05). There were no significant differences in the incidence of bradycardia, hypotension, postoperative fatigue, and constipation between the two groups (P > 0.05).Conclusion The combination of esketamine and dexmedetomidine with TAP block during gynecological laparoscopy anesthesia helps to reduce postoperative pain and decrease the incidence of postoperative nausea and vomiting.