术中持续输注艾司氯胺酮对腹腔镜结直肠癌手术患者术后睡眠质量的影响

doi:10.3877/cma.j.issn.1674-0793.2023.06.002

目的

评价术中持续小剂量输注艾司氯胺酮对腹腔镜结直肠癌手术患者术后睡眠质量的影响。

方法

选择2023年1月至6月中南大学湘雅医学院附属常德医院择期行腹腔镜结直肠癌根治术患者80例，年龄18~65岁，ASA Ⅰ~Ⅲ级，采用随机数字表法分为艾司氯胺酮组（E组）和对照组（C组），各40例。E组在诱导插管后开始持续输注艾司氯胺酮0.2 mg·kg^-1·h^-1至手术结束，C组输注等容积0.9%氯化钠溶液，其他麻醉用药、手术方案及术后处理相同。术前1 d（D_-1）和术后第1天（D₁）、第7天（D₇）早晨采用匹兹堡睡眠质量指数量表评分（PSQI）和抑郁自评量表（SDS）评估患者睡眠质量和抑郁情况；术前2晚（D_-2）、术后当晚（D₀）、术后第6晚（D₆）佩戴运动手表，D₆行多导睡眠图，记录睡眠结构情况。记录患者手术一般资料及D₁、D₂、D₃的NRS疼痛评分。

结果

与C组相比，E组PSQI和SDS评分在D₁ （t=5.528、4.517，P<0.001、<0.001）、D₇（t=4.162、2.976，P<0.001、0.031）较低，E组在D₀、D₆时睡眠时间较长（t=5.185、4.662，P<0.001、<0.001），睡眠效率较高（t=4.485、2.717，P<0.001、0.041），入睡后觉醒时间较短（t=3.852、3.906，P=0.003、<0.001），D₀时入睡潜伏期较短（t=5.586，P<0.001），D₁时NRS疼痛评分较低（t=4.112，P<0.001），D₁、D₂镇痛泵按压次数（χ²=5.168、4.926，P<0.001、<0.001）和补救镇痛例数较少（χ²=2.558、3.887，P=0.041、<0.001），术中瑞芬太尼用量较少，差异均有统计学意义（t=3.262，P=0.011）。

结论

术中持续小剂量输注艾司氯胺酮可改善腹腔镜结直肠癌手术患者术后睡眠质量，促进患者术后快速康复。

关键词: 艾司氯胺酮, 腹腔镜, 结直肠肿瘤手术, 术后睡眠障碍

Objective

To evaluate the effect of continuous low-dose intravenous infusion of esketamine on postoperative sleep quality of patients undergoing laparoscopic colorectal cancer surgery.

Methods

Eighty patients (18-65 years old, ASAⅠ-Ⅲ) undergoing laparoscopic radical resection of colorectal cancer in Changde Hospital, Xiangya School of Medicine were randomly divided into the esketamine group (E group) and the control group (C group), with 40 cases in each group. After induction and intubation, group E were continuously infused 0.2 mg·kg^-1·h^-1 of esketamine until the end of the operation. Group C were infused with 0.9% physiological saline of the same volume. Other anesthetic drugs, surgical procedures and postoperative treatment were the same. Pittsburgh Sleep Quality Index (PSQI) and Self Rating Depression Scale (SDS) were used to assess the patients’ sleep quality and depression on the first day before operation (D_-1), the first day after operation (D₁), and the morning of the 7th day (D₇). Wearing a sports watch 2 nights before surgery (D_-2), the same night after surgery (D₀), and the 6th night after surgery (D₆), a polysomnography was performed at D₆ to record the sleep structure from 22:00 to 6:00 the next day. The patients’ general surgical information and postoperative NRS pain scores on the 1st (D₁), 2nd (D₂), and 3 (D₃) day were recorded.

Results

Compared with Group C, Group E had lower PSQI and SDS scores at D₁ (t=5.528, 4.517, P<0.001, <0.001) and D₇ (t=4.162, 2.976, P<0.001, 0.031), while Group E had longer sleep time (t=5.185, 4.662, P<0.001, <0.001), higher sleep efficiency (t=4.485, 2.717, P<0.001, 0.041), and shorter awakening time after falling asleep (t=3.852, 3.906, P=0.003, <0.001) at D₀ and D₆. The latency for falling asleep (t=5.586, P<0.001) at D₀ was shorter, and the NRS pain score was lower at D₁ (t=4.112, P<0.001). The number of D₁, D₂ analgesic pump compressions (χ²=5.168, 4.926, P<0.001, <0.001) and cases of rescue analgesia (χ²=2.558, 3.887, P=0.041, <0.001) were fewer. The amount of remifentanil used during surgery was less, and the differences were statistically significant (t=3.262, P=0.011).

Conclusion

Continuous low-dose infusion of esketamine during operation can improve the sleep quality of patients undergoing laparoscopic colorectal cancer surgery, and promote the rapid recovery of patients after surgery.

Key words: Esketamine, Laparoscopy, Colorectal cancer surgery, Postoperative sleep disturbances

表1 两组行腹腔镜结直肠癌手术患者一般资料比较（±s，t检验）

组别	例数	年龄(岁)	体质指数(kg/m²)	手术时间(min)	麻醉时间(min)	苏醒时间(min)	丙泊酚用量(mg)	舒芬太尼用量(μg)	瑞芬太尼用量(μg)
E组	39	67.25±7.17	24.53±4.92	153.6±32.8	181.7±48.5	25.82±8.63	1 036.2±122.7	65.8±8.9	752.5±105.3
C组	38	65.82±6.73	25.02±5.13	145.9±35.7	175.6±46.2	28.11±8.92	998.6±117.5	68.2±10.1	1 348.1±216.5
t值		0.512	0.428	0.572	0.533	0.596	0.615	0.527	3.262
P值		0.653	0.703	0.624	0.638	0.612	0.572	0.641	0.011

表1 两组行腹腔镜结直肠癌手术患者一般资料比较（±s，t检验）

组别	例数	年龄(岁)	体质指数(kg/m²)	手术时间(min)	麻醉时间(min)	苏醒时间(min)	丙泊酚用量(mg)	舒芬太尼用量(μg)	瑞芬太尼用量(μg)
E组	39	67.25±7.17	24.53±4.92	153.6±32.8	181.7±48.5	25.82±8.63	1 036.2±122.7	65.8±8.9	752.5±105.3
C组	38	65.82±6.73	25.02±5.13	145.9±35.7	175.6±46.2	28.11±8.92	998.6±117.5	68.2±10.1	1 348.1±216.5
t值		0.512	0.428	0.572	0.533	0.596	0.615	0.527	3.262
P值		0.653	0.703	0.624	0.638	0.612	0.572	0.641	0.011

表2 两组行腹腔镜结直肠癌手术患者不同时间点PSQI和SDS评分的比较（分，±s，t检验）

组别	例数	PSQI评分			SDS评分
组别	例数	D_-1	D₁	D₇	D_-1	D₁	D₇
E组	39	6.12±2.53	12.37±4.21^ab	9.25±3.85^ab	35.72±8.62	55.45±11.37^ab	43.61±9.85^ab
C组	38	5.98±2.59	16.85±5.19^a	11.57±3.65^a	37.33±8.51	66.39±14.25^a	50.52±10.35^a
t值		0.375	5.528	4.162	0.521	4.517	2.976
P值		0.822	<0.001	<0.001	0.649	<0.001	0.031

表2 两组行腹腔镜结直肠癌手术患者不同时间点PSQI和SDS评分的比较（分，±s，t检验）

组别	例数	PSQI评分			SDS评分
组别	例数	D_-1	D₁	D₇	D_-1	D₁	D₇
E组	39	6.12±2.53	12.37±4.21^ab	9.25±3.85^ab	35.72±8.62	55.45±11.37^ab	43.61±9.85^ab
C组	38	5.98±2.59	16.85±5.19^a	11.57±3.65^a	37.33±8.51	66.39±14.25^a	50.52±10.35^a
t值		0.375	5.528	4.162	0.521	4.517	2.976
P值		0.822	<0.001	<0.001	0.649	<0.001	0.031

表3 两组行腹腔镜下结直肠癌手术患者睡眠结构比较（±s，t检验）

组别	睡眠时间(min)			睡眠效率(%)			入睡潜伏期(min)			入睡后觉醒时间(min)
组别	D_-2	D₀	D₆	D_-2	D₀	D₆	D_-2	D₀	D₆	D_-2	D₀	D₆
E组(39例)	415.2±21.2	313.6±33.5^ab	432.3±31.6^b	86.2±5.6	65.6±6.9^ab	89.2±7.3^b	21.6±5.2	33.5±7.9^ab	18.7±5.6	42.6±8.3	133.7±19.5^ab	30.1±7.6^b
C组(38例)	421.3±25.6	250.7±22.8^a	389.7±28.2^a	87.5±5.9	52.3±6.3^a	81.1±6.7^a	19.8±4.6	42.2±10.1^a	21.3±7.1	39.8±7.8	187.3±25.6^a	69.3±11.5^a
t值	0.452	5.185	4.662	0.276	4.485	2.717	0.386	5.586	0.596	0.621	3.852	3.906
P值	0.713	<0.001	<0.001	0.885	<0.001	0.041	0.752	<0.001	0.475	0.462	0.003	<0.001

表3 两组行腹腔镜下结直肠癌手术患者睡眠结构比较（±s，t检验）

组别	睡眠时间(min)			睡眠效率(%)			入睡潜伏期(min)			入睡后觉醒时间(min)
组别	D_-2	D₀	D₆	D_-2	D₀	D₆	D_-2	D₀	D₆	D_-2	D₀	D₆
E组(39例)	415.2±21.2	313.6±33.5^ab	432.3±31.6^b	86.2±5.6	65.6±6.9^ab	89.2±7.3^b	21.6±5.2	33.5±7.9^ab	18.7±5.6	42.6±8.3	133.7±19.5^ab	30.1±7.6^b
C组(38例)	421.3±25.6	250.7±22.8^a	389.7±28.2^a	87.5±5.9	52.3±6.3^a	81.1±6.7^a	19.8±4.6	42.2±10.1^a	21.3±7.1	39.8±7.8	187.3±25.6^a	69.3±11.5^a
t值	0.452	5.185	4.662	0.276	4.485	2.717	0.386	5.586	0.596	0.621	3.852	3.906
P值	0.713	<0.001	<0.001	0.885	<0.001	0.041	0.752	<0.001	0.475	0.462	0.003	<0.001

表4 两组行腹腔镜结直肠癌手术患者D₆多导睡眠图比较（±s，t检验）

组别	例数	睡眠时间(min)	睡眠效率(%)	入睡潜伏期(min)	入睡后觉醒时间(min)
E组	39	434.1±32.2^a	89.5±7.4^a	18.2±5.5	28.2±7.4^a
C组	38	390.5±28.7	81.5±7.2	20.9±6.9	68.5±11.2
t值		4.623	2.695	0.579	3.879
P值		<0.001	0.042	0.502	<0.001

表4 两组行腹腔镜结直肠癌手术患者D₆多导睡眠图比较（±s，t检验）

组别	例数	睡眠时间(min)	睡眠效率(%)	入睡潜伏期(min)	入睡后觉醒时间(min)
E组	39	434.1±32.2^a	89.5±7.4^a	18.2±5.5	28.2±7.4^a
C组	38	390.5±28.7	81.5±7.2	20.9±6.9	68.5±11.2
t值		4.623	2.695	0.579	3.879
P值		<0.001	0.042	0.502	<0.001

表5 两组行腹腔镜结直肠癌手术患者术后疼痛情况比较

组别	例数	NRS疼痛评分(分)			镇痛泵按压次数			补救镇痛（例）
组别	例数	D₁	D₂	D₃	D₁	D₂	D₃	D₁	D₂	D₃
E组	39	3.78±1.35^ab	3.22±1.14^a	2.71±0.95^a	31^b	22^b	8	5^b	1^b	0
C组	38	4.59±1.77	3.59±1.17	3.05±1.06	61	45	13	12	6	2
统计值		4.112	0.525	0.489	5.168	4.926	0.756	2.558	3.887	0.635
P值		<0.001	0.498	0.521	<0.001	<0.001	0.285	0.041	<0.001	0.452

表5 两组行腹腔镜结直肠癌手术患者术后疼痛情况比较

组别	例数	NRS疼痛评分(分)			镇痛泵按压次数			补救镇痛（例）
组别	例数	D₁	D₂	D₃	D₁	D₂	D₃	D₁	D₂	D₃
E组	39	3.78±1.35^ab	3.22±1.14^a	2.71±0.95^a	31^b	22^b	8	5^b	1^b	0
C组	38	4.59±1.77	3.59±1.17	3.05±1.06	61	45	13	12	6	2
统计值		4.112	0.525	0.489	5.168	4.926	0.756	2.558	3.887	0.635
P值		<0.001	0.498	0.521	<0.001	<0.001	0.285	0.041	<0.001	0.452

表6 两组行腹腔镜结直肠癌手术患者术后不良反应比较（例，χ²检验）

组别	例数	呼吸抑制	恶心	呕吐	头痛
E组	39	1	11	6	1
C组	38	2	9	5	0
χ²值		0.217	0.312	0.186	0.285
P值		0.855	0.758	0.896	0.811

表6 两组行腹腔镜结直肠癌手术患者术后不良反应比较（例，χ²检验）

组别	例数	呼吸抑制	恶心	呕吐	头痛
E组	39	1	11	6	1
C组	38	2	9	5	0
χ²值		0.217	0.312	0.186	0.285
P值		0.855	0.758	0.896	0.811

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Effect of continuous infusion of esketamine on postoperative sleep quality of patients undergoing laparoscopic colorectal cancer surgery

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Effect of continuous infusion of esketamine on postoperative sleep quality of patients undergoing laparoscopic colorectal cancer surgery