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

Abstract

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

CLC Number:

R614.2

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.

Figures/Tables 5

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References 27

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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

Effect of subanesthetic dose of esketamine on emergence agitation in patients undergoing laparoscopic hernia repair

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