术前艾司氯胺酮联合竖脊肌平面阻滞对胸腔镜手术患者术后疲劳综合征及神经认知功能的影响OA

Objective To explore the impact of preoperative administration of esketamine combined with erector spinae plane block(ESPB)on postoperative fatigue syndrome(POFS)and postoperative neurocognitive dysfunction(PND)in patients undergoing thoracoscopic surgery.Methods A total of 80 patients who un-derwent thoracoscopic surgery in our hospital from August 2023 to November 2024 were selected and randomly divided into an observation group and a control group,with 40 patients in each group.Patients in the control group received intravenous-inhalation combined general anesthesia.Patients in the observation group received additional preoperative esketamine combined with erector spinae plane block based on the anesthesia and post-operative analgesia regimen of the control group.The basic clinical data of the two groups of patients were com-pared and analyzed.Before the operation,on the 1st,3rd and 7th days after the operation,the POFS and PND were evaluated through Fatigue Assessment Index(FAI)and Mini-Mental State Examination(MMSE).The dosage of intraoperative opioids and the occurrence of perioperative adverse reactions were observed.Results There were no differences between the two groups in age,BMI,surgical site,surgical procedure,anesthesia duration,or operation time(P>0.05).Preoperative FAI scores showed no difference between the two groups(P>0.05).On postoperative day 1,FAI scores in both groups significantly increased(P<0.05).On postop-erative days 3 and 7,FAI scores returned to near-preoperative levels(P>0.05).At all postoperative time points,FAI scores in the observation group were significantly lower than those in the control group(P<0.05).Preoperative MMSE scores showed no difference between the two groups(P>0.05).On postoperative day 1,MMSE scores in both groups were significantly decreased(P<0.05).On postoperative days 3 and 7,MMSE scores returned to near-preoperative levels(P>0.05).At all postoperative time points,MMSE scores in the observation group were significantly higher than those in the control group(P<0.05).The total dosage of remifentanil and the dosage per unit body weight in the observation group were significantly lower than those in the control group(P<0.05).The incidence of adverse reactions in the observation group and the control group was 10%and 25%respectively(P>0.05).Conclusion Preoperative administration of esketamine com-bined with erector spinae plane block in patients undergoing thoracoscopic surgery can alleviate the severity of early postoperative fatigue syndrome and neurocognitive dysfunction,accelerate postoperative recovery,reduce in-traoperative opioid consumption,and has a favorable safety profile,warranting clinical application and promotion.