亚麻醉剂量艾司氯胺酮对腹腔镜疝修补术患者苏醒期躁动的影响

doi:10.3969/j.issn.1006-5725.2025.17.017

摘要/Abstract

摘要：

目的探索亚麻醉剂量艾司氯胺酮对腹腔镜疝修补术患者苏醒期躁动的影响。方法选取全麻下行腹腔镜疝修补术的男性患者72例，随机分为亚麻醉剂量艾司氯胺酮组（AS组）和对照组。AS组手术结束前30 min静脉注射0.2 mg/kg艾司氯胺酮，对照组给予同体积生理盐水。手术结束后患者直接送入麻醉恢复室（PACU）。记录拔管时间，拔管即刻、拔管10 min、拔管30 min、拔管1 h、拔管4 h血流动力学变化，采用躁动-镇静评分（RASS）和视觉模拟评估量表（VAS）对上述时间点患者躁动-镇静和疼痛评估，意识模糊评分量表（CAM-ICU）记录患者苏醒期间谵妄发生率，PACU留观时间，术后24 h采用40项恢复质量量表评分（QoR-40）评估恢复质量及不良事件。结果与对照组相比，AS组患者拔管10 min后HR、MAP较高，且HR、MAP随时间的变化更为稳定（P < 0.05）；AS组在拔管即刻及后续各时间点的RASS、VAS评分均显著低于对照组（P < 0.05），两组的RASS、VAS评分都会随时间变化（P < 0.05），但AS组的变化过程更为平稳（P < 0.05）；与对照组相比，AS组患者术后拔管时间、PACU留观时间、术后谵妄、呼吸抑制、恶心呕吐差异无统计学意义（P > 0.05），恢复质量显著提升（P < 0.05）。结论亚麻醉剂量艾司氯胺酮能减轻腹腔镜疝修补术后患者疼痛和苏醒期躁动，同时维持患者在PACU中血流动力学的稳定，提高复苏质量，值得临床推广。

关键词: 亚麻醉剂量, 艾司氯胺酮, 苏醒期躁动, 腹腔镜疝修补术

Abstract:

Objective To investigate the effect of subanesthetic dose of esketamine on emergence agitation （EA） in patients undergoing laparoscopic hernia repair. Methods Seventy?two male patients who treated with laparoscopic hernia repair under general anesthesia were randomly divided into AS group （subanesthetic esketamine） and control group. In the AS group， 0.2 mg/kg of esketamine was administered intravenously 30 minutes before the surgery ended， while the control group was given an equal volume of normal saline. Upon surgery completion， patients were transferred to PACU with endotracheal tube retained， and the time to extubation was recorded. Hemodynamic parameters were measured immediately after extubation and at 10 min， 30 min， 1 h， and 4 h thereafter. Patients′ pain and sedation levels were assessed at the above time points using RASS and VAS， respectively. The incidence of EA was evaluated using the Confusion Assessment Method for the Intensive Care Unit （CAM?ICU）. Observation duration in the PACU and recovery outcomes within 24 hours postoperatively were assessed via the QoR?40 and adverse events were recorded. Results Compared to those in the control group， patients in the AS group had higher HR and MAP at 10 min post?extubation， and the changes in HR and MAP over time were more stable（P < 0.05）. The RASS and VAS scores in the AS group were significantly lower than those in the control group at the time of extubation and all subsequent time points（P < 0.05）， both groups showed temporal changes in RASS and VAS scores （P < 0.05）， but the change process in the AS group was more stable（P < 0.05）. Postoperative extubation time， PACU observation duration， and adverse event rates （delirium， respiratory depression， nausea and vomiting） did not differ significantly between the two groups （P > 0.05）， while recovery quality was markedly better in the AS group （P < 0.05）. Conclusion Subanesthetic esketamine effectively alleviates pain and the incidence of EA， supports hemodynamic stability during PACU stay， and enhances recovery quality in patients undergoing laparoscopic hernia repair， demonstrating clinical value.

Key words: subanesthetic dose, esketamine, emergence agitation, laparoscopic hernia repair

中图分类号:

R614.2

王秋韵,李明成,顾慧芸,塔娜,其丽格,朱立东,高敬,曹兴华. 亚麻醉剂量艾司氯胺酮对腹腔镜疝修补术患者苏醒期躁动的影响[J]. 实用医学杂志, 2025, 41(17): 2728-2733.

Qiuyun WANG,Mingcheng LI,Huiyun GU,Na TA,Lige QI,Lidong ZHU,Jing GAO,Xinghua CAO. Effect of subanesthetic dose of esketamine on emergence agitation in patients undergoing laparoscopic hernia repair[J]. The Journal of Practical Medicine, 2025, 41(17): 2728-2733.

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参考文献 27

[1]	CAI Y H， ZHONG J W， MA H Y， et al. Effect of Remimazolam on Emergence Delirium in Children Undergoing Laparoscopic Surgery： A Double-blinded Randomized Trial ［J］. Anesthesiology， 2024， 141（3）： 500-510. doi:10.1097/aln.0000000000005077 doi: 10.1097/aln.0000000000005077
[2]	WEGNER G R M， WEGNER B F M， OLIVEIRA H G， et al. Pharmacological and non-pharmacological interventions in patients undergoing nasal surgeries for prevention of emergence agitation： A systematic review and network meta-analysis ［J］.Braz J Anesthesiol， 2025， 75（1）： 844565. doi:10.1016/j.bjane.2024.844565 doi: 10.1016/j.bjane.2024.844565
[3]	MENG T， LIN X， LI X， et al. Pre-anesthetic use of butorphanol for the prevention of emergence agitation in thoracic surgery： A multicenter， randomized controlled trial ［J］. Front Med， 2022， 9： 1040168. doi:10.3389/fmed.2022.1040168 doi: 10.3389/fmed.2022.1040168
[4]	PANG N Q， NG C S Y， WONG C J H. Laparoscopic versus open groin hernia repair in older adults： A systematic review and meta-analysis ［J］. ANZ J Surg， 2022， 92（10）： 2457-2463. doi:10.1111/ans.18032 doi: 10.1111/ans.18032
[5]	刘力玮，孔二亮，李雨恒，等. 艾司氯胺酮与舒芬太尼用于肥胖患者腹腔镜下胃袖状切除术麻醉诱导对术后疼痛影响的比较［J］. 实用医学杂志， 2024， 40（17）： 2454-2459.
[6]	WEI B， FENG Y， CHEN W， et al. Risk factors for emergence agitation in adults after general anesthesia： A systematic review and meta-analysis ［J］. Acta Anaesthesiol Scand， 2021， 65（6）： 719-729. doi:10.1111/aas.13774 doi: 10.1111/aas.13774
[7]	ZHENG L， WANG Y， MA Q， et al. Efficacy and Safety of a Subanesthetic Dose of Esketamine Combined with Propofol in Patients with Obesity Undergoing Painless Gastroscopy： A Prospective， Double-Blind， Randomized Controlled Trial ［J］. Drug Des Devel Ther， 2023， 17： 1347-1356. doi:10.2147/dddt.s408076 doi: 10.2147/dddt.s408076
[8]	MIN M， DU C， CHEN X， et al. Effect of subanesthetic dose of esketamine on postoperative rehabilitation in elderly patients undergoing hip arthroplasty ［J］. J Orthop Surg Res， 2023， 18（1）： 268. doi:10.1186/s13018-023-03728-2 doi: 10.1186/s13018-023-03728-2
[9]	HAN C， JI H， GUO Y， et al. Effect of Subanesthetic Dose of Esketamine on Perioperative Neurocognitive Disorders in Elderly Undergoing Gastrointestinal Surgery： A Randomized Controlled Trial ［J］. Drug Des Devel Ther， 2023， 17： 863-873. doi:10.2147/dddt.s401161 doi: 10.2147/dddt.s401161
[10]	LIU J， WANG T， SONG J， et al. Effect of esketamine on postoperative analgesia and postoperative delirium in elderly patients undergoing gastrointestinal surgery ［J］. BMC Anesthesiol， 2024， 24（1）： 46. doi:10.1186/s12871-024-02424-w doi: 10.1186/s12871-024-02424-w
[11]	连一闻，马艳辉，刘海霞，等. 性别因素对艾司氯胺酮复合环泊酚在门诊无痛胃肠镜检查麻醉效果的疗效观察［J］. 北京医学， 2024， 46（5）： 401-404.
[12]	XU Y， TUNG T H， FENG X， et al. The effect of magnesium sulfate on emergence agitation in surgical adult patients undergoing general anesthesia： A systematic review and meta-analysis of randomized controlled trials ［J］. J Clin Anesth， 2024， 96： 111499. doi:10.1016/j.jclinane.2024.111499 doi: 10.1016/j.jclinane.2024.111499
[13]	LEE S， SOHN J Y， HWANG I E， et al. Effect of a repeated verbal reminder of orientation on emergence agitation after general anaesthesia for minimally invasive abdominal surgery： A randomised controlled trial ［J］. Br J Anaesth， 2023， 130（4）： 439-445. doi:10.1016/j.bja.2022.12.009 doi: 10.1016/j.bja.2022.12.009
[14]	DUAN J， JU X， WANG X， et al. Effects of Remimazolam and Propofol on Emergence Agitation in Elderly Patients Undergoing Hip Replacement： A Clinical， Randomized， Controlled Study ［J］. Drug Des Devel Ther， 2023， 17： 2669-2678. doi:10.2147/dddt.s419146 doi: 10.2147/dddt.s419146
[15]	LI J， ZHU H， WANG Y， et al. Remifentanil is Superior to Propofol for Treating Emergence Agitation in Adults After General Anesthesia ［J］. Drug Des Devel Ther， 2024， 18： 341-350. doi:10.2147/dddt.s433155 doi: 10.2147/dddt.s433155
[16]	SONG J L， YE Y， HOU P， et al. Remimazolam vs. propofol for induction and maintenance of general anesthesia： A systematic review and meta-analysis of emergence agitation risk in surgical populations ［J］. J Clin Anesth， 2025， 103： 111815. doi:10.1016/j.jclinane.2025.111815 doi: 10.1016/j.jclinane.2025.111815
[17]	HUANG X， CAI J， LV Z， et al. Postoperative pain after different doses of remifentanil infusion during anaesthesia： A meta-analysis ［J］. BMC Anesthesiol， 2024， 24（1）： 25. doi:10.1186/s12871-023-02388-3 doi: 10.1186/s12871-023-02388-3
[18]	REN Y L， YUAN J J， XING F， et al. Effects of Different Doses of Esketamine on Pain Sensitivity of Patients Undergoing Thyroidectomy： A Randomized Controlled Trial ［J］. Pain Ther， 2023， 12（3）： 739-750. doi:10.1007/s40122-023-00488-z doi: 10.1007/s40122-023-00488-z
[19]	NI EOCHAGAIN A， CAROLAN S， BUGGY D J. Regional anaesthesia truncal blocks for acute postoperative pain and recovery： A narrative review ［J］. Br J Anaesth， 2024， 132（5）： 1133-1145. doi:10.1016/j.bja.2023.12.020 doi: 10.1016/j.bja.2023.12.020
[20]	LI T， DONG T， CUI Y， et al. Effect of regional anesthesia on the postoperative delirium： A systematic review and meta-analysis of randomized controlled trials ［J］. Front Surg， 2022， 9： 937293. doi:10.3389/fsurg.2022.937293 doi: 10.3389/fsurg.2022.937293
[21]	JEN C K， LU K C， CHEN K W， et al. Oral Dexmedetomidine Achieves Superior Effects in Mitigating Emergence Agitation and Demonstrates Comparable Sedative Effects to Oral Midazolam for Pediatric Premedication： A Systematic Review and Meta-Analysis of Randomized Controlled Studies ［J］. J Clin Med， 2024， 13（4）： 1174. doi:10.3390/jcm13041174 doi: 10.3390/jcm13041174
[22]	李玮，柳权，黄兰姬，等. 艾司氯胺酮对保留自主呼吸全身麻醉单孔胸腔镜手术患者呼吸的影响［J］. 实用医学杂志， 2024， 40（13）： 1859-1863. doi:10.3969/j.issn.1006-5725.2024.13.016 doi: 10.3969/j.issn.1006-5725.2024.13.016
[23]	ZHU T， YUAN C， QIAN M， et al. Effect of dexmedetomidine on intracranial pressure in patients undergoing gynecological laparoscopic surgery in Trendelenburg position through ultrasonographic measurement of optic nerve sheath diameter ［J］. Am J Transl Res， 2022， 14（9）： 6349-6358.
[24]	KANG H Y， YOU A H， KIM Y， et al. Respiration monitoring in PACU using ventilation and gas exchange parameters ［J］. Sci Rep， 2021， 11（1）： 24312. doi:10.1038/s41598-021-03639-4 doi: 10.1038/s41598-021-03639-4
[25]	QIU D， WANG X M， YANG J J， et al. Effect of Intraoperative Esketamine Infusion on Postoperative Sleep Disturbance After Gynecological Laparoscopy： A Randomized Clinical Trial ［J］. JAMA Netw Open， 2022， 5（12）： e2244514. doi:10.1001/jamanetworkopen.2022.44514 doi: 10.1001/jamanetworkopen.2022.44514
[26]	MION G， HIMMELSEHER S. Esketamine： Less Drowsiness， More Analgesia ［J］. Anesth Analg， 2024， 139（1）： 78-91. doi:10.1213/ane.0000000000006851 doi: 10.1213/ane.0000000000006851
[27]	李银桥，赵科勇. 艾司氯胺酮辅助丙泊酚方案对无痛胃镜患者呼吸循环稳定性及认知功能的影响［J］. 现代医学与健康研究电子杂志， 2025， 9（5）： 107-110.

组别	年龄/岁	身高/cm	体质量/kg	BMI/（kg/m²）
AS组	50.08 ± 13.20	178.69 ± 5.29	82.27 ± 6.43	25.75 ± 1.47
对照组	53.03 ± 12.59	176.13 ± 5.71	80.81 ± 6.87	26.04 ± 1.76
t值	0.89	570.5	634.00	624.00
P值	> 0.05	> 0.05	> 0.05	> 0.05

项目	手术时长	麻醉时长
AS组	3.40 ± 0.45	3.80 ± 0.47
对照组	3.22 ± 0.47	3.62 ± 0.49
t值	1.145	1.611
P值	> 0.05	> 0.05

观察指标	组别	例数	拔管即刻	拔管10 min	拔管30 min	拔管1 h	拔管4 h
HR/（次/min）	AS组	36	80.39 ± 12.33	85.56 ± 11.4	80.17 ± 13.40	75.61 ± 11.58	76.72 ± 11.43
HR/（次/min）	对照组	36	81.36 ± 9.18	77.89 ± 9.36	73.64 ± 8.91	68.67 ± 8.42	64.33 ± 7.80
	F值		F_组间 = 8.54, F_时间 = 67.42, F_交互 = 15.33
	P值		P_组间 < 0.05, P_时间 < 0.05, P_交互 < 0.05
MAP/mmHg	AS组	36	87.33 ± 11.88	89.97 ± 9.40	89.56 ± 8.45	85.86 ± 8.63	83.69 ± 6.88
MAP/mmHg	对照组	36	89.64 ± 9.28	85.17 ± 10.88	85.03 ± 9.79	81.08 ± 6.63	78.17 ± 5.55
	F值		F_组间 = 4.04, F_时间 = 22.66, F_交互 = 5.78
	P值		P_组间 < 0.05, P_时间 < 0.05, P_交互 < 0.05

观察指标	组别	例数	拔管即刻	拔管10 min	拔管30 min	拔管1 h	拔管4 h
RASS	AS组	36	-0.42 ± 0.90	-0.28 ± 0.66	-0.19 ± 0.79	-0.36 ± 0.64	-0.11 ± 0.78
RASS	对照组	36	1.11 ± 0.95	1.22 ± 0.80	1.53 ± 0.74	1.89 ± 0.71	2.22 ± 0.54
	F值		F_组间 = 252.20， F_时间 = 13.17， F_交互 = 6.96
	P值		P_组间 < 0.05， P_时间 < 0.05， P_交互 < 0.05
VAS	AS组	36	2.42 ± 1.11	2.53 ± 0.94	2.72 ± 1.21	2.81 ± 0.95	2.64 ± 0.72
VAS	对照组	36	3.14 ± 0.80	3.50 ± 0.81	3.61 ± 1.15	4.11 ± 0.95	4.64 ± 1.10
	F值		F_组间 = 55.48， F_时间 = 13.01， F_交互 = 7.06
	P值		P_组间 < 0.05， P_时间 < 0.05， P_交互 < 0.05

组别	例数	拔管时间/min	留观时间/min	谵妄/［例（%）］	呼吸抑制/［例（%）］	恶心呕吐/［例（%）］	QoR-40评分
AS组	36	14.69 ± 5.77	54.50 ± 19.13	5（13.9）	4（11.1）	5（13.9）	164.67 ± 6.36
对照组	36	12.83 ± 5.14	49.92 ± 18.27	3（8.3）	6（16.7）	7（19.4）	140.28 ± 6.03
t/χ²值		1.45	1.04	0.56	0.47	0.40	16.70
P值		> 0.05	> 0.05	> 0.05	> 0.05	> 0.05	< 0.05