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投稿时间：2026-02-09 网络发布日期：2026-07-30
投稿时间：2026-02-09 网络发布日期：2026-07-30
中文摘要: 目的 探讨围手术期使用艾司氯胺酮对行腹腔镜下结直肠癌根治术患者术后急性疼痛、血流动力学参数、脑电双频指数（BIS）及不良反应的影响。方法 选取2023年9月至2024年2月在中南大学湘雅医院接受择期腹腔镜下结直肠癌根治术的成年患者作为研究对象。按1∶1比例将研究对象随机分为C组和PE组，每组各有58例患者完成研究。C组采用全凭静脉麻醉及患者自控静脉镇痛（PCIA）。PE组在C组基础上使用0.5 mg/kg艾司氯胺酮静脉麻醉诱导，同时PCIA 中加用艾司氯胺酮1 mg/kg。研究主要结局指标为患者拔管时以及术后6、12、24、48 h 的视觉模拟评分法（VAS）评分。次要结局指标包括患者术中血流动力学参数［心率（HR）、平均动脉压（MAP）］、BIS、PCIA 按压次数、镇痛泵余量、抢救性药物追加率及术后住院时间、术后不良反应。结果 两组PCIA 按压次数以及术后24 h、48 h 的镇痛泵余量差异均无统计学意义（P>0.05）。两组VAS 评分存在时间效应（P<0.01），而未见组间效应和交互效应（P>0.05）。两组组内VAS 评分随时间变化的差异有统计学意义（PE 组Wald χ2=212.266，P<0.01；C 组Wald χ2=100.665，P<0.01），但两组术后组间VAS 评分比较差异无统计学意义（P>0.05）。两组HR、MAP、BIS 均存在时间效应（P<0.01），但仅MAP、BIS 存在交互效应（P<0.01）。仅在诱导麻醉后5 min PE 组MAP 值高于C 组［85.5（78.8，90.2）mmHg vs 76.5（71.0，84.0）mmHg，χ2=16.255，P<0.01］。从插管后5 min 开始，PE 组的BIS 值均高于C 组（P<0.05）。两组术后不良反应发生情况比较差异无统计学意义（P>0.05）。结论 围手术期使用艾司氯胺酮不会显著影响结直肠癌患者的术后VAS评分，但其在麻醉诱导后改善了MAP和BIS值，且未显著增加不良反应。
Abstract:Objective To explore the effects of perioperative esketamine on postoperative acute pain，hemodynamic parameters，bispectral index（BIS）and adverse reactions in patients undergoing laparoscopic radical resection for colorectal cancer. Methods Adult patients undergoing elective laparoscopic radical resection of colorectal cancer at Xiangya Hospital of Central South University from September 2023 to February 2024 were enrolled. They were randomly assigned in a 1∶1 ratio to group C and group PE，with 58 patients in each group completing the study. Patients in group C received total intravenous anesthesia and patient-controlled intravenous analgesia（PCIA），while patients in group PE received an additional intravenous induction dose of 0.5 mg/kg esketamine and PCIA with 1 mg/kg esketamine based on group C. The primary outcome was the Visual Analogue Scale（VAS）score at extubation and at 6，12，24，and 48 hours postoperatively. Secondary outcomes included intraoperative hemodynamic parameters［heart rate（HR），mean arterial pressure（MAP）］，BIS，number of PCIA presses，residual analgesic volume in the pump，rescue analgesic administration rate，postoperative hospital stay，and postoperative adverse reactions. Results There was no significant difference between the two groups in the number of PCIA presses or residual analgesic volume at 24 h and 48 h postoperatively（P>0.05）. VAS scores showed a significant inter-time effect（P<0.01），but no inter-group or interaction effect（P>0.05）. Intra - group analysis revealed significant changes in VAS scores over time（group PE：Wald χ2=212.266，P<0.01；group C：Wald χ2=100.665，P<0.01），but no significant difference in VAS scores between two groups postoperatively（P>0.05）. HR，MAP，and BIS all showed a significant inter-time effect（P<0.01），while only MAP and BIS showed a significant interaction effect（P<0.01）. Only 5 min after induction of anesthesia，MAP in group PE was higher than that in group C［85.5（78.8，90.2）mmHg vs 76.5（71.0，84.0）mmHg，χ2=16.255，P<0.01］. From 5 min after intubation，BIS values in group PE were higher than those in group C（P<0.05）. No significant difference was observed in the incidence of postoperative adverse reactions between the two groups（P>0.05）. Conclusion Perioperative use of esketamine does not significantly affect postoperative VAS scores in patients with colorectal cancer. However，esketamine improves MAP and BIS values after induction of anesthesia without significantly increasing adverse reactions.
keywords: Esketamine Visual Analogue Scale Pain Colorectal cancer Mean arterial pressure Bispectral index Patient-controlled intravenous analgesia Residual analgesic volume in the pump
文章编号： 中图分类号：R614 文献标志码：A
基金项目:湖南省卫生健康委卫生科研课题（A202304116001）
附件
| Author Name | Affiliation |
| HE Lindai，SUN Zhihua，GUO Qulian，LI Longyan，LI Shenxiayu | Anesthesiology Department,Xiangya Hospital of Central South University,Changsha,Hunan 410008,China |
引用文本：
何林岱，孙志华，郭曲练，李龙艳，李申夏宇.艾司氯胺酮对结直肠癌患者术后急性疼痛的影响[J].中国临床研究,2026,39(7):989-994.
何林岱，孙志华，郭曲练，李龙艳，李申夏宇.艾司氯胺酮对结直肠癌患者术后急性疼痛的影响[J].中国临床研究,2026,39(7):989-994.