艾司氯胺酮联合竖脊肌平面阻滞在老年患者腹腔镜胆囊切除术中的临床研究OA

Objective To investigate the effect of esketamine injection combined with erector spinae plane block in elderly patients undergoing laparoscopic cholecystectomy(LC).Methods Patients aged 60 years and older scheduled for laparoscopic cholecystectomy(LC)were enrolled in the study and divided into control group and treatment group based on anesthesia method.Both groups received erector spinae plane block.The control group was induced with intravenous midazolam injection 0.05 mg·kg-1,sufentanil citrate injection 0.4-0.6 μg·kg-1,propofol injectable emulsion 1.5-2.0 mg·kg-1,and cisatracurium besylate injection 0.2 mg·kg-1;the treatment group received the same induction regimen plus intravenous esketamine hydrochloride injection 0.2 mg·kg-1.During surgery,the control group maintained anesthesia with continuous infusion of propofol injectable emulsion at 3-6 mg·(kg·h)-1 and remifentanil hydrochloride for injection at 0.1-0.25 μg·(kg·h)-1,along with intermittent bolus injections of cisatracurium besylate injection at 0.1-0.2 mg·kg-1 to maintain neuromuscular blockade.The treatment group received the same maintenance regimen as the control group,but additionally infused esketamine hydrochloride injection continuously at 0.2 mg·(kg·h)-1.Anesthesia parameters,hemodynamic indices,stress markers,postoperative recovery,cognitive function,and adverse events were compared between the two groups.Results The control group included 121 cases and the treatment group included 116 cases.The remifentanil hydrochloride for injection dosage in the control group and treatment group were(1 002.38±171.54)and(844.27±153.05)μg,respectively;the postoperative patient-controlled analgesia(PCA)sufentanil citrate injection dosage was(7.68±1.74)and(7.21±0.99)μg,respectively;the effective pressing times of patient-controlled intravenous analgesia(PCIA)pump were(6.35±1.43)and(5.12±1.05)times,respectively;the number of agitated patients at T3 was 5.79％(7 cases/121 cases)and 0.86％(1 case/116 cases),respectively;the nitric oxide(NO)level at 2 h after surgery was(39.64±5.08)and(35.28±5.93)μmol·L-1,respectively;the endothelin-1(ET-1)level at 2 h after surgery was(53.82±8.46)and(58.63±8.76)pg·mL-1,respectively;the cortisol(Cor)level at 48 h after surgery was(13.04±1.96)and(12.45±1.87)μg·dL-1,respectively;the angiotensin Ⅱ(Ang Ⅱ)level at 48 h after surgery was(23.74±3.49)and(22.65±3.18)pg·mL-1,respectively;the norepinephrine(NE)level at 48 h after surgery was(182.57±35.03)and(172.86±24.56)ng·L-1,respectively;at 48 hours after surgery,the scores of the Mini-Mental State Examination(MMSE)were(25.58±3.16)and(26.45±2.07)points,respectively;the Quality of Life 40(QoR40)were(178.37±14.24)and(182.65±13.08)points,respectively.The differences of above indicators between two groups were all statistically significant(all P＜0.05).The main adverse reactions in the two groups were nausea and vomiting,respiratory depression,dizziness and skin itching.The total incidence of adverse reactions in the control group(15.70％,19 cases/121 cases)was significantly higher than that in the treatment group(6.90％,8 cases/116 cases)(P＜0.05).Conclusion Esketamine injection combined with erector spinae plane block in elderly patients undergoing LC can provide good anesthesia effect,enhance analgesic effect,maintain the stability of respiratory and circulatory indicators,regulate vasoactive indicators,reduce stress response,improve cognitive function,promote postoperative recovery,and has good safety.