艾司氯胺酮麻醉诱导与维持对老年胃癌手术患者血流动力学和脑氧代谢的影响

Effects of esketamine induction and maintenance on hemodynamics and cerebral oxygen metabolism in elderly patients undergoing gastric cancer surgery

摘要:

目的 探讨艾司氯胺酮麻醉诱导与维持对老年胃癌手术患者血流动力学和脑氧代谢的影响。方法 选取2023年1月—2025年1月在唐山市工人医院接受胃癌手术的102例患者为研究对象，采用随机数字表法分为观察组和对照组，各51例。观察组麻醉诱导时持续静脉泵注0.25 mg/（kg·h）艾司氯胺酮，麻醉维持时静脉泵注0.25 mg/（kg·h）艾司氯胺酮至手术结束前30 min；对照组在相应时点给予等量生理盐水；其余所用麻醉诱导及维持药物两组相同。记录患者麻醉前（T₀）、切皮时（T₁）、手术开始15 min（T₂）、手术结束时（T₃）的心率（HR）和平均动脉压（MAP），比较两组患者的睁眼时间、拔管时间、PACU停留时间和术后住院时间；比较两组患者术前和术后24 h神经损伤生物标志物［中枢神经特异性蛋白β（S100β）、神经元特异性烯醇化酶（NSE）］和脑氧代谢动力学参数［颈静脉血氧饱和度（SjvO₂）、脑动静脉血氧含量差（Da-jvO₂）、脑氧摄取率（CERO₂）］；记录不良反应发生情况。结果 观察组与对照组术后T₀、T₁、T₂、T₃的MAP和HR比较，采用重复测量设计的方差分析，结果 ①不同时间点的MAP、HR比较，差异有统计学意义（P <0.05）；②两组的MAP、HR比较，差异有统计学意义（P <0.05），观察组MAP和HR更稳定；③两组MAP、HR的变化趋势比较，差异有统计学意义（P <0.05）。观察组术后住院时间短于对照组（P <0.05）。观察组治疗后S100β、NSE均低于对照组（P <0.05）；观察组治疗前后S100β、NSE的差值均小于对照组（P <0.05）。观察组治疗后SjvO₂低于对照组，Da-jvO₂、CERO₂高于对照组（P <0.05）；观察组治疗前后SjvO₂、Da-jvO₂、CERO₂的差值均小于对照组（P <0.05）。观察组与对照组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 艾司氯胺酮麻醉诱导可有效维持老年胃癌手术患者术中血流动力学稳定，改善术后脑氧代谢，缩短术后住院时间，且未增加不良反应总发生率。

Abstract:

Objective To investigate the effects of esketamine induction and maintenance on hemodynamics and cerebral oxygen metabolism in elderly patients undergoing gastric cancer surgery.Methods A total of 102 patients scheduled for gastric cancer surgery at Tangshan Workers' Hospital between January 2023 and January 2025 were enrolled and randomly assigned to either an observation group or a control group (n = 51 each) using a random number table. Patients in the observation group received continuous intravenous infusion of esketamine at 0.25 mg/(kg·h) starting from anesthesia induction and maintained at the same rate until 30 minutes before the end of surgery. The control group received an equivalent volume of normal saline at the corresponding time points, while all other anesthetic induction and maintenance drugs were identical between the two groups. Heart rate (HR) and mean arterial pressure (MAP) were recorded at the following time points: before anesthesia (T₀), at skin incision (T₁), 15 minutes after surgery initiation (T₂), and at the end of surgery (T₃). Eye-opening time, extubation time, post-anesthesia care unit (PACU) stay duration, and postoperative hospital stay were compared. Neurological function markers [central nervous system-specific protein β (S100β), neuron-specific enolase (NSE) ] and cerebral metabolism parameters [jugular venous oxygen saturation (SjvO₂), cerebral arteriovenous oxygen content difference (Da-jvO₂), cerebral oxygen extraction rate (CERO₂) ] were measured before surgery and 24 hours postoperatively. Adverse reactions were also recorded.Results A repeated-measures analysis of variance was used to compare MAP and HR between the two groups at T₀, T₁, T₂, and T₃. The results showed that: There were statistically significant differences in MAP and HR across different time points (P < 0.05); there were statistically significant differences in MAP and HR between the observation group and the control group (P < 0.05), with the observation group demonstrating more stable MAP and HR. the trends of change in MAP and HR over time were significantly different between the two groups (P < 0.05). The postoperative hospital stay was significantly shorter in the observation group compared to the control group (P < 0.05). At 24 hours postoperatively, the levels of S100β and NSE in the observation group were significantly lower than those in the control group (P < 0.05), and the changes in S100β and NSE levels from pre- to post-operation were also smaller in the observation group (P < 0.05). Similarly, at 24 hours postoperatively, the SjvO₂ in the observation group was significantly lower than that in the control group, while the Da-jvO₂ and CERO₂ were significantly higher (P < 0.05). The changes in SjvO₂, Da-jvO₂, and CERO₂ from pre- to post-operation were also more favorable in the observation group compared to the control group (P < 0.05). No statistically significant difference was found in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusion Esketamine induction and maintenance helps maintain intraoperative hemodynamic stability, improves postoperative cerebral oxygen metabolism, shortens postoperative hospital stay, and does not increase the overall incidence of adverse reactions in elderly patients undergoing gastric cancer surgery.