目的 探讨降噪耳机隔离术中噪声对食管胃病变内镜下黏膜下剥离术后早期恢复质量的影响。 方法 该研究为前瞻性平行随机对照临床研究，选择2023年8月至2024年2月于气管插管全身麻醉下行择期食管或胃病变内镜下黏膜下剥离术的患者，年龄≥18岁，性别不限，ASAⅠ-Ⅳ级，采用随机数字表法分为观察组与对照组，观察组在全身麻醉下手术中使用降噪耳机来降低噪声强度，对照组不进行噪声隔离，记录术中平均噪声强度和噪声强度≥ 70 dB的术中时间比例。观察并比较的主要结局指标是15项恢复质量评分量表（QoR-15）测量的术后24 h恢复质量，次要结局指标包括：术后48 h的QoR-15评分；术后拔管即刻、离开复苏室时、术后24 h、48 h视觉模拟疼痛评分表（VAS）测量的静息和运动诱发疼痛评分，术中与术后48 h内镇痛药物消耗量；术后48 h采用匹兹堡睡眠指数（PSQI）量表评估的睡眠质量评分。 结果 与对照组比较，观察组术后24 h的QoR-15评分显著升高［（123.43 ± 5.92） vs. （119.75 ± 6.62）， t = 3.211， P = 0.002］。观察组术后拔管即刻静息VAS评分［1（0，3） vs. 2（2，3）， Z = -3.755， P < 0.001］与运动VAS评分［2（1，3） vs. 3（2，3）， Z = -2.959， P = 0.002］均显著低于对照组，离开复苏室时、术后24 h、48 h的静息和运动VAS评分两组差异无统计学意义（P > 0.05）。与对照组比较，观察组术中芬太尼用量显著降低［（0.23 ± 0.05） vs. （0.27 ± 0.06）， t = 3.515， P = 0.01］，术中瑞芬太尼用量及术后48 h内氟比洛芬酯补救镇痛次数差异无统计学意义（P > 0.05）。同时，观察组术后PSQI评分较对照组显著降低［（5.40 ± 2.57） vs. （6.63 ± 3.23）， t = 2.313， P = 0.022］。 结论 在全身麻醉食管胃病变内镜下黏膜下剥离术中，应用降噪耳机进行术中噪声隔离是一种安全有效的提高术后恢复质量、缓解术后疼痛和降低镇痛药物总消耗量的策略。

Objective To investigate the impact of noise isolation through the use of noise-cancelling headphones on the quality of postoperative recovery following esophageal or gastric endoscopic submucosal dissection. Methods This is a prospective， parallel-group， randomized controlled clinical trial. Patients aged 18 years or older， regardless of gender and with ASA physical status Ⅰ- Ⅳ， who underwent elective esophageal or gastric endoscopic submucosal dissection under general anesthesia with endotracheal intubation from August 2023 to February 2024 were randomly assigned to either a control group or an observation group using a random number table. In the observation group， noise-cancelling headphones were used to reduce intraoperative noise intensity during general anesthesia， while the control group did not receive any noise isolation measures. The study recorded the average noise intensity during surgery and the proportion of intraoperative time with noise intensity ≥ 70 dB. The primary outcome was the quality of recovery at 24 hours postoperatively， assessed using the 15-item Quality of Recovery Scale （QoR-15）. Secondary outcomes included QoR-15 scores at 48 hours postoperatively， resting and movement-evoked pain scores measured by the Visual Analog Pain Scale （VAS） immediately after extubation， upon leaving the resuscitation room， and at 24 and 48 hours postoperatively， as well as analgesic drug consumption during surgery and within 48 hours postoperatively. Additionally， sleep quality was evaluated using the Pittsburgh Sleep Quality Index （PSQI） at 48 hours postoperatively. Results Compared with the control group， the observation group exhibited a significant increase in QoR-15 score at 24 hours post-surgery ［（123.43 ± 5.92） vs. （119.75 ± 6.62）， t = 3.211， P = 0.002］. The resting VAS score ［1（0，3） vs. 2（2，3）， Z = -3.755， P < 0.001］ and movement-evoked VAS score ［2（1，3） vs. 3（2，3）， Z = -2.959， P = 0.003］ of the observation group immediately after extubation were significantly lower than those of control group. There was no significant difference in resting and movement-evoked VAS scores between the two groups when leaving the resuscitation room or at 24 and 48 hours after surgery （P > 0.05）. The intraoperative fentanyl consumption was significantly lower in the observation group compared to the control group ［（0.23 ± 0.05） vs. （0.27 ± 0.06）， t = 3.515， P = 0.01］. There were no significant differences in remifentanil consumption during surgery or in the frequency of rescue analgesia with flurbiprofen axetil within 48 hours post-surgery （P > 0.05）. Postoperative PSQI scores were significantly lower in the observation group compared to the control group ［（5.40 ± 2.57） vs. （6.63 ± 3.23）， t = 2.313， P = 0.022］. Conclusion The use of noise-cancelling headphones for intraoperative noise isolation is a safe and effective strategy that enhances postoperative recovery quality， alleviates postoperative pain， and decreases the overall consumption of analgesic drugs in patients undergoing endoscopic submucosal dissection of esophageal and gastric lesions under general anesthesia.