| 李颖,李雅楠,王利利.艾司氯胺酮对腹腔镜子宫全切术病人术后情绪的影响[J].安徽医药,2025,29(11):2307-2311. |
| 艾司氯胺酮对腹腔镜子宫全切术病人术后情绪的影响 |
| Effect of esketamine on postoperative mood in patients undergoing laparoscopic total hysterectomy |
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| DOI：10.3969/j.issn.1009-6469.2025.11.041 |
| 中文关键词: 情绪 艾司氯胺酮 腹腔镜子宫全切术 正性负性情绪量表 镇痛 不良反应 |
| 英文关键词: Emotion Esketamine Laparoscopic total hysterectomy Positive and negative affect scale Analgesia Adverse re-actions |
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| 中文摘要: |
| 目的探讨艾司氯胺酮对腹腔镜子宫全切术病人术后情绪的影响。方法选取 2022年 12月至 2023年 6月在山西医科大学第二医院择期行腹腔镜子宫全切术的 118例病人。按照随机数字表法分为 0.5 mg/kg艾司氯胺酮组( S组)、生理盐水组( C组)每组 59例。 S组切皮前 1 min静脉注射 0.5 mg/kg艾司氯胺酮(以生理盐水稀释至 10 g/L)，以 0.125 mg·kg.1·h.1(以生理盐水稀释至，1 g/L)维持，于手术结束前 30 min停药； C组注射等体积生理盐水。其余麻醉诱导、维持、术后镇痛用药方案完全一致。用正性负性情绪量表( PANAS)记录病人术前 1d及术后 2d情绪评分；记录病人静息( T1)、插管( T2)、切皮( T3)、建立气腹(T4)、术中平均值( T5)、关闭气腹( T6)、拔管( T7)、拔管后 15 min(T8)的心率和平均动脉压( MAP)；记录术中升压药物使用例数、术后镇静评分；记录术后补救镇痛、止吐例数及住院时长。结果两组术前正性及负性评分均差异无统计学意义( P>0.05)S组病人术后 2d正性情绪评分高于 C组［(26.07±2.24)分比( 24.85±2.54)分］(P<0.05)负性情绪评分低于 C组［(16.20± 2.33比( 17.59±2.65)分］(P<0.05)；两组心率、 MAP时间效应显著( P<0.05)而组间效应差统计学意义( P>0.05)； Rasmay)分，异无，镇静评分的时间效应与组间效应均显著( P<0.05)；相较于 C组， S组术中使用升，压药物例数更少［ 15.25%(9/59)比30.51%(18/ 59)，P<0.05］。两组术后补救镇痛与止吐例数以及住院时长差异无统计学意义( P>0.05)。结论艾司氯胺酮可使腹腔镜子宫全切术病人术后情绪得以改善，对苏醒时长无影响，拔管时躁动更轻，术中血流动力学更加稳定，但不能减少术后补救性镇痛、止吐药物使用。 |
| 英文摘要: |
| Objective To investigate the effect of esketamine on postoperative mood in patients undergoing laparoscopic total hyster-ectomy.Methods A total of 118 patients scheduled for elective laparoscopic total hysterectomy at the Second Hospital of Shanxi Medi-cal University from December 2022 to June 2023 were selected. They were divided into a 0.5 mg/kg esketamine group (group S) and anormal saline group (group C) according to the random number table, with 59 patients in each group. Group S received an intravenousinjection of 0.5 mg/kg esketamine (diluted to 10 g/L with normal saline) 1 min before skin incision, maintained at 0.125 mg·kg.1·h.1 (di-luted to 1 g/L with normal saline), and discontinued 30 min before the end of surgery. Group C received an equal volume of normal sa-line. The other anesthesia induction, maintenance, and postoperative analgesia protocols were identical. The Positive and Negative Af-fect Schedule (PANAS) was used to record mood scores 1 day before surgery and 2 days after surgery. Heart rate (HR) and mean arteri-al pressure (MAP) were recorded at rest (T1), after intubation (T2), after skin incision (T3), after pneumoperitoneum establishment (T4),at the intraoperative mean value (T5), after pneumoperitoneum closure (T6), after extubation (T7), and 15 min after extubation (T8). Thenumber of patients requiring intraoperative vasopressors, postoperative sedation scores, the number of patients requiring postoperativerescue analgesia and antiemetics, and the length of hospital stay were recorded.Results There were no statistically significant differ-ences in preoperative positive and negative scores between the two groups (P>0.05). On postoperative day 2, the positive emotion score Group S was higher than that in Group C (26.07±2.24 vs. 24.85±2.54) (P<0.05), and the negative emotion score was lower than that in Group C (16.20±2.33 vs. 17.59±2.65) (P<0.05). HR and MAP showed significant time effects in both groups (P<0.05), but no signifi-cant intergroup effects (P>0.05). The Ramsay sedation score showed significant time and intergroup effects (P<0.05). Compared with Group C, Group S had fewer patients requiring intraoperative vasopressors [15.25% (9/59) vs. 30.51% (18/59), P<0.05]. There were nostatistically significant differences in the number of patients requiring postoperative rescue analgesia or antiemetics, or in the length ofhospital stay between the two groups (P>0.05).Conclusions Esketamine can improve postoperative mood in patients undergoing lapa-roscopic total hysterectomy, has no effect on awakening time, results in less agitation during extubation, and provides more stable intra-operative hemodynamics. However, it does not reduce the need for postoperative rescue analgesia or antiemetic drugs. |
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