艾司氯胺酮对经腹全子宫切除术患者免疫功能、应激反应、血流动力学的影响

Effects of esketamine on the immune function,stress response and hemodynamics in patients undergoing total abdominal hysterectomy

摘要

目的 探讨艾司氯胺酮与依托咪酯腹横肌平面阻滞(TAPB)对经腹全子宫切除术患者麻醉的效果。方法 选取2021年5月至2024年5月于齐齐哈尔市第一医院收治的行经腹全子宫切除术患者120例为研究对象,随机分为参照组、研究组各60例。参照组采用TAPB+依托咪酯,研究组采用TAPB+依托咪酯+艾司氯胺酮。比较两组患者围术期指标、免疫功能、应激反应、血流动力学指标、术后疼痛情况及不良反应发生情况。结果 与参照组比较,研究组拔管时间、恢复室停留时间、镇痛泵按压次数均减少,差异有统计学意义(t值分别为13.165、5.074、23.229,P<0.05);术后研究组CD3⁺、CD4⁺、CD4⁺/CD8⁺水平均高于参照组,多巴胺(DA)、去甲肾上腺素(NE)水平均低于参照组,差异有统计学意义(t值介于2.750~8.273之间,P<0.05);两组心率(HR)、平均动脉压(MAP)在不同时间点及组间的主效应差异显著,且存在交互作用(F_交互值分别为2.744、4.149,P<0.05),进一步分析显示与参照组相比,研究组T1(插管时)、T2(手术开始30 min后)时HR、MAP水平显著低于参照组(P<0.05);术后两组不同时间点、组间数字疼痛评分法(NRS)评分主效应差异显著,但无交互作用(F_交互=2.212,P>0.05),进一步分析显示与参照组相比,研究组术后6 h、12 h、24 h NRS评分显著低于参照组(P<0.05);两组皮肤瘙痒、呼吸遗忘等不良反应发生率差异无统计学意义(P>0.05)。结论 相较于接受依托咪酯腹横肌平面阻滞麻醉,行经腹全子宫切除术患者接受艾司氯胺酮联合依托咪酯麻醉,可有效减轻机体术后疼痛,降低免疫损伤,效果较为理想,临床应用价值较高。

Abstract

Objective To investigate the anesthetic effects of esketamine combined with etomidate-based transversus abdominis plane block (TAPB) in patients undergoing total abdominal hysterectomy. Methods A total of 120 patients who underwent total abdominal hysterectomy at The First Hospital of Qiqihar from May 2021 to May 2024 were enrolled and randomly divided into a reference group and a study group,with 60 patients in each group.The reference group received TAPB combined with etomidate anesthesia,while the study group received TAPB combined with etomidate and esketamine anesthesia.Perioperative indicators,immune function,stress response,hemodynamic parameters,postoperative pain,and adverse reactions were compared between the two groups. Results Compared with the reference group,the study group showed significantly shorter extubation time,post-anesthesia care unit stay time,and fewer presses of the analgesia pump (t=13.165,5.074,and 23.229,respectively,P<0.05).Postoperatively,levels of CD3 ⁺,CD4 ⁺,and CD4 ⁺/CD8 ⁺ in the study group were significantly higher than those in the reference group,whereas levels of dopamine (DA) and norepinephrine (NE) were significantly lower (t values ranging from 2.750 to 8.273,P<0.05).Significant main effects of time and group,as well as significant interaction effects,were observed for heart rate (HR) and mean arterial pressure (MAP) (F_interaction=2.744 and 4.149,respectively,P<0.05).Further analysis demonstrated that HR and MAP levels at T1 (during intubation) and T2 (30 min after the beginning of surgery) were significantly lower in the study group than in the reference group (P<0.05).Significant main effects of time and group were also observed for numerical rating scale (NRS) scores after surgery,whereas no interaction effect was identified (F_interaction=2.212,P>0.05).Further analysis showed that NRS scores at 6 h,12 h,and 24 h postoperatively were significantly lower in the study group than in the reference group (P<0.05).No statistically significant differences were found between the two groups in the incidence of adverse reactions,such as pruritus and respiratory forgetfulness (P>0.05). Conclusion Compared with etomidate-based TAPB anesthesia alone,esketamine combined with etomidate anesthesia in patients undergoing total abdominal hysterectomy can effectively alleviate postoperative pain and reduce immune injury,demonstrating favorable efficacy and high clinical application value.

关键词

全子宫切除术 / 艾司氯胺酮 / 免疫功能 / 血流动力学 / 应激反应

Key words

total abdominal hysterectomy / esketamine / immune function / hemodynamics / stress response

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基金资助

齐齐哈尔市科技计划创新激励项目(CSFGG-2024042)