兰州大学学报（医学版）2024，Vol.50Issue(2)：25-30,38,7.DOI:10.13885/j.issn.1000-2812.2024.02.005
围手术期静脉泵注艾司氯胺酮对妇科腹腔镜手术患者术后胃肠功能的影响
Effect of esketamine on postoperative gastrointestinal function in patients after gynecological laparoscopic surgery
摘要
Abstract
Objective To observe the effects of different doses of esketamine on postoperative gastrointestinal function in patients after gynecologic laparoscopic surgery.Methods 90 patients were selected to undergo laparoscopic hysterectomy or uterine smooth muscle tumor removal under general anesthesia,and all patients were randomly divided into three groups:the control group(group C),the 0.25 mg/(kg·h)esketamine group and the 0.50 mg/(kg·h)esketamine group(group S2).Different doses of esketamine were injected(group S1 intravenically from 10.0 min before anesthesia induction to 30.0 min before the end of surgery,and the control group was given the same amount of normal saline.Other anesthesia regimens were consistent among the 3 groups.Venous blood was collected to detect intestinal fatty acid-binding proteinlm(I-FABP)and Claudin-1 protein concentrations,the changes of patients'heart rate and mean arterial pressure were recorded,the time of patients'first exhaust defecation after surgery,I-FEED score within 72 h and the occurrence of postoperative adverse reactions were followed up.Results Compared with that before pneumoperitoneum,the serum I-FABP concentration in groups C,S1 and S2 was increased at 1 h after pneumoperitoneum(P<0.05),and the serum I-FABP concentration in group S2 lower than that in group C at 1 h after pneumoperitoneum(P<0.05).Compared with that before pneumoperitoneum,the serum Claudin-1 protein concentration in group S2 was increased at 1 h after pneumoperitoneum and 1 h after the end of pneumoperitoneum(P<0.05),and higher than that in group C(P<0.05).Compared with group C,the intraoperative dosage of remifentanil and propofol in group S1 was decreased(P<0.05),and the frequency of vasoactive drugs in group S2 was signifi-cantly decreased(P<0.05).Comparison of the occurrence of adverse reactions of I-FEED score,the time of first gas and bowel movement,dizziness,and nightmare in the three groups within 72 h after surgery showed no statistically significant difference(P>0.05).Conclusion Gynecological laparoscopic surgery can affect the intestinal barrier function.Perioperative intravenous injection of esketamine can up-regulate the expression of Clau din-1 protein and reduce the serum I-FABP content,which correlates with increased intestinal barrier stability,thereby promoting recovery of the gastrointestinal function.In addition,perioperative use of esket-amine may not increase patients'I-FEED score and time to first exhaust bowel movement within 72 hours.关键词
艾司氯胺酮/肠屏障/紧密连接/子宫肌瘤/全身麻醉/胃肠道功能Key words
esketamine/intestinal barrier/tight junction/uterine leiomyoma/general anesthesia/gastrointesti nal function分类
医药卫生引用本文复制引用
张丽,王迎斌,刘艳,曹璐,张伟..围手术期静脉泵注艾司氯胺酮对妇科腹腔镜手术患者术后胃肠功能的影响[J].兰州大学学报（医学版）,2024,50(2):25-30,38,7.基金项目
兰州大学第二医院"萃英科技创新"计划资助项目(CY2022-MS-A20) （CY2022-MS-A20）
