目的 观察和比较艾司氯胺酮与舒芬太尼全麻诱导用于肥胖患者腹腔镜下胃袖状切除术后镇痛效果的影响。 方法 选择拟行择期全麻腹腔镜下胃袖状切除术的患者，性别不限，年龄20 ~ 50岁，BMI 30.0 ~ 50.0 kg/m²，ASA Ⅰ或Ⅱ级。将患者随机分为两组：艾司氯胺酮组（E组）和舒芬太尼组（S组）各32例。两组在麻醉诱导时分别给予艾司氯胺酮0.5 mg/kg（E组）与舒芬太尼0.5 μg/kg（S组），其余方案一致。记录入室（T0）、麻醉诱导前（T1）、麻醉诱导后即刻（T2）、插管时（T3）、麻醉结束时（T4）、拔管时（T5）的HR、MAP、SpO₂。记录术后1 h（P0）、6 h（P1）、12 h（P2）、24 h（P3）、48 h（P4）时刻NRS疼痛评分，记录两组患者术中瑞芬太尼消耗量及术后48 h内镇痛泵按压次数。记录不良反应发生情况。 结果 术中情况比较，两组患者T0 ~ T5时刻MAP与HR比较差异均无统计学意义（P > 0.05）。同T0相比，T2时刻两组MAP与HR均较低，T2时刻S组MAP和HR分别为（91.81 ± 8.94）mmHg和（81.75 ± 13.37）次/min，E组MAP和HR分别为（93.69 ± 9.96）mmHg和（80.38 ± 13.2）次/min，E组更接近基础值；同T2相比，T3时刻两组患者MAP与HR均有一过性升高，T3时刻S组MAP和HR分别为（97.56 ± 8.96）mmHg和（86.47 ± 13.84）次/min，E组MAP和HR分别为（101.03 ± 8.29）mmHg和（89.41 ± 15.32）次/min，且S组更接近基础值。S组和E组患者术中瑞芬太尼使用量比较分别为（2 071.88 ± 717.63）μg和（2 093.75 ± 718.39）μg，差异无统计学意义（P > 0.05）。两组患者术后情况比较，E组在P0、P1、P2时候NRS评分（0.41 ± 0.61、1.87 ± 0.75、2.47 ± 0.62）低于S组（0.88 ± 0.71、2.47 ± 0.72、2.97 ± 0.54），差异有统计学意义（P < 0.05），E组患者术后静脉镇痛泵按压次数也明显减少（P < 0.05），S组和E组术后镇痛泵按压次数分别为（11.25 ± 2.70）次和（8.56 ± 2.23）次。E组患者PONV与低血压发生率（21.88%，15.63%）均低于S组（46.88%，37.50%），差异有统计学意义（P < 0.05）。 结论 与舒芬太尼诱导相比，艾司氯胺酮麻醉诱导可安全用于肥胖患者腹腔镜下胃袖状切除术，能够有效减轻患者术后急性疼痛，并减少术后恶心呕吐发生率。

Objective To observe and compare of the effects of esketamine and sufentanil induction for general anesthesia on postoperative analgesia in obese patients undergoing laparoscopic sleeve gastrectomy. Methods Patients scheduled for elective laparoscopic sleeve gastrectomy between March 2023 and March 2024， irrespective of gender， aged between 20 and 50 years， with a BMI ranging from 30.0 to 50.0 kg/m² and ASA Ⅰ or Ⅱ classification， were randomly allocated into two groups： the esketamine group （Group E） and the sufentanil group （Group S）， each consisting of 32 cases. During anesthesia induction， Group E received a dose of esketamine at 0.5 mg/kg while Group S received sufentanil at a dosage of 0.5 μg/kg； the remaining protocol remained unchanged. Heart rate （HR）， mean arterial pressure （MAP）， and SpO₂ were recorded at various time points： upon arrival （T0）， prior to anesthesia induction （T1）， immediately after induction （T2）， during intubation （T3）， at the conclusion of anesthesia administration（T4）， and during extubation（T5）. Postoperative pain scores using the Numeric Rating Scale（NRS） were assessed at specific intervals following surgery： one hour post?surgery（P0）， six hours post?surgery（P1）， twelve hours post?surgery（P2）， twenty?four hours post?surgery（P3）and forty?eight hours post?surgery（P4）. Additionally， intraoperative remifentanil consumption as well as the number of presses on the analgesic pump within forty?eight hours after surgery in both patient groups were documented along with any occurrences of adverse reactions. Results During the surgery， there was no statistically significant difference in mean arterial pressure （MAP） and heart rate （HR） between the two patient groups at T0 ~ T5 （P > 0.05）. At T2， both groups exhibited lower MAP and HR compared to T0； specifically， group S had a MAP of （91.81±8.94） mmHg and HR of （81.75 ± 13.37） beats/min， while group E had a MAP of （93.69 ± 9.96） mmHg and HR of （80.38 ± 13.2） beats/min， with group E showing values closer to baseline levels. At T3， both groups experienced a transient increase in MAP and HR （P < 0.05）； specifically， group S had a MAP of （97.56 ± 8.96） mmHg and HR of （86.47 ± 13.84） beats/min， while group E had a MAP of （101.03 ± 8.29） mmHg and （89.41 ± 15.32） times/min， with S group closer to baseline values. There was no statistically significant difference in the amount of remifentanil used during surgery between group S and group E （P > 0.05）， which were （2 071.88 ± 717.63） μg and （2 093.75 ± 718.39） μg， respectively. Compared with the postoperative conditions of the two groups， the NRS scores of group E （0.41 ± 0.61 ± 1.870.75， 2.47 ± 0.62） at P0， P1 and P2 were lower than those in group S （0.88 ± 0.71， 2.47 ± 0.72， 2.97 ± 0.54）， and the difference was statistically significant （P < 0.05）. The number of intravenous analgesia pump presses was significantly reduced in group E after surgery （P < 0.05）， with the postoperative analgesic pump compressions occurring 11.25±2.70 times in group S and 8.56 ± 2.23 times in group E. The incidence of postoperative nausea and vomiting （PONV） and hypotension in Group E （21.88%， 15.63%） was lower than that observed in group S （46.88%， 37.50%）， demonstrating statistical significance （P < 0.05）. Conclusion In comparison to sufentanil induction， the utilization of esketamine anesthesia induction is deemed safe for laparoscopic sleeve gastrectomy in obese patients， effectively mitigating postoperative acute pain and reducing the incidence of PONV.