亚麻醉剂量艾司氯胺酮联合丙泊酚对腹腔镜结直肠癌根治术后患者认知功能的影响

The effect of sub-anesthetic dose esketamine combined with propofol on cognitive function in patients undergoing laparoscopic radical resection of colorectal cancer

摘要

目的: 探讨亚麻醉剂量艾司氯胺酮联合丙泊酚在腹腔镜结直肠癌根治术中的应用价值。方法 选取2022年6月至2024年12月行腹腔镜结直肠癌根治术的 110 例患者,采用信封法将患者分为观察组（n=55,予以亚麻醉剂量艾司氯胺酮联合丙泊酚麻醉）与对照组（n=55,常规麻醉）,对比分析两组不同时点平均动脉压、心率、手术时间、麻醉时间、术中失血量、机械通气时间、麻醉后监测治疗室停留时间、苏醒时间、蒙特利尔认知评估量表评分、术后认知障碍发生率、肿瘤坏死因子-α、 C 反应蛋白、白细胞介素 -6 等相关指标。结果 麻醉后 5 min 、麻醉后 30 min 、手术结束时,观察组平均动脉压高于对照组 （P<0.05）;麻醉后 5 min 、麻醉后 30 min 时,观察组心率低于对照组（P<0.05）。两组手术时间、麻醉时间、术中失血量、机械通气时间、麻醉后监测治疗室停留时间、苏醒时间差异无统计学意义（P>0.05）。术后 24 h,观察组血清肿瘤坏死因子 -α、 C 反应蛋白、白细胞介素-6 低于对照组（P<0.05）,蒙特利尔认知评估量表评分高于对照组（P<0.05）。观察组术后认知障碍发生率低于对照组（P<0.05）。术后 24 h 内,观察组镇痛泵有效按压次数、总按压次数少于对照组（P<0.05）。结论 亚麻醉剂量艾司氯胺酮联合丙泊酚用于腹腔镜结直肠癌根治术,可维持患者血流动力学稳定,减轻术后认知功能损伤,值得临床推广应用。

Abstract

Objective: To explore the application value of sub-anesthetic dose esketamine combined with propofol in laparosco- pic radical resection of colorectal cancer. Methods: A total of 110 patients who underwent laparoscopic radical resection for colorectal cancer from Jun. 2022 to Dec. 2024 were selected.The patients were divided into the observation group（n=55, receiving sub-anesthetic dose esketamine combined with propofol for anesthesia）and the control group（n=55, receiving conventional anesthesia）by envelope method.The related indicators of the two groups were compared and analyzed, including mean arterial pressure, heart rate at different time points, operation time, anesthesia time, intraoperative blood loss, mechanical ventilation time, post-anesthesia care unit stay time, recovery time, Montreal cognitive assessment scale score, incidence of postoperative cognitive impairment, tumor necrosis factor-a, C- reactive protein, and interleukin-6. Results: At 5 min after anesthesia, 30 min after anesthesia and at the end of the operation, the mean arterial pressure of the observation group was higher than that of the control group（P<0.05）; at 5 min after anesthesia and 30 min after anesthesia, the heart rate of the observation group was lower than that of the control group（P<0.05）.There was no statistically signifi- cant difference between the two groups in operation time, anesthesia time, intraoperative blood loss, mechanical ventilation time, post- anesthesia care unit stay time, and recovery time（P>0.05）. At 24 h after operation, the serum levels of tumor necrosis factor-α, C-reac-tive protein and interleukin-6 in the observation group were lower than those in the control group（P<0.05）, and the Montreal cognitive assessment scale score was higher than that in the control group（P<0.05）.The incidence of postoperative cognitive impairment in the observation group was lower than that in the control group（P<0.05）.Within 24 h after operation, the effective pressing times and total pressing times of the analgesic pump in the observation group were fewer than those in the control group（P<0.05）. Conclusions: The application of sub-anesthetic dose esketamine combined with propofol in laparoscopic radical resection of colorectal cancer can maintain the stability of patients' hemodynamics, reduce postoperative cognitive impairment, and is worthy of clinical promotion and application.

关键词

结直肠肿瘤 / 结直肠癌根治术 / 腹腔镜检查 / 艾司氯胺酮 / 丙泊酚 / 亚麻醉剂量

Key words

Colorectal neoplasms / Radical resection of colorectal cancer / Laparoscopy / Esketamine / Propofol / Subanesthetic dose