鞘内注射氯胺酮对妇科良性腹腔镜手术后胃肠功能的影响：一项双盲、随机对照研究。
Effects of intraoperative esketamine addition on gastrointestinal function after benign gynaecological laparoscopic surgery: a double-blind, randomized controlled study.
机构信息
Department of Anesthesiology, Xing'an Meng People's Hospital, Inner Mongolia Autonomous Region, Xing'an Meng, Inner Mongolia, 137400, China.
Department of Anesthesiology, Peking University People's Hospital, Beijing, 100044, China.
出版信息
BMC Anesthesiol. 2023 Jun 23;23(1):220. doi: 10.1186/s12871-023-02184-z.
BACKGROUND
Gastrointestinal hypokinesis can occur transiently after benign gynecologic surgery. Opioids cause the side effect of postoperative gastrointestinal hypokinesis, but an opioid-sparing anaesthetic protocol based on esketamine reduces intraoperative opioid consumption. Therefore, this study hypothesised that an opioid-sparing anaesthetic protocol based on esketamine would shorten the gastrointestinal function recovery time after benign gynaecological laparoscopic surgery.
METHODS
This was a prospective randomized controlled double-blind study conducted in a single centre. All patients scheduled for elective benign laparoscopic gynaecological surgery at Xing'an Meng People's Hospital, Inner Mongolia Autonomous Region, from November 2021 to April 2022 were consecutively enrolled and randomly divided into the opioid-sparing anaesthesia group (Group OS) and the conventional anaesthesia group (Group C). Postoperative first exhaust time, feeding time and postoperative nausea and/or vomiting (PONV) were analyzed in both groups.
RESULTS
A total of 71 patients were enrolled in this study, including 35 in Group OS and 36 in Group C. The general condition, operative time, type of surgery, intraoperative bleeding, intraoperative fluid volume and intraoperative urine volume were not statistically different between the two groups. Compared with Group C, significantly shorter first postoperative flatus time (11 [8, 14] h vs. 14 [11, 18], p = 0.003) and anaesthesia resuscitation time (7 [6, 9] h vs. 9 [7, 11] h, p = 0.013)were observed in the OS group. The incidence of PONV in Group OS was significantly lower compared with Group C (11.4% vs. 41.7%, p = 0.007).
CONCLUSION
The esketamine-based opioid-sparing anaesthetic protocol can shorten the postoperative first flatus time after benign laparoscopic surgery in gynaecology, and reduce the incidence of PONV. In addition, the application of esketamine may reduce the postoperative opioid dose requirement of patients.
TRIAL REGISTRATION
This study was registered with the China Clinical Trials Registry (registration number: ChiCTR2100052528, 30/10/2021).
背景
良性妇科手术后会短暂出现胃肠道动力不足。阿片类药物会导致术后胃肠道动力不足的副作用，但基于依托咪酯的阿片类药物节约型麻醉方案可减少术中阿片类药物的使用。因此，本研究假设基于依托咪酯的阿片类药物节约型麻醉方案可缩短良性妇科腹腔镜手术后胃肠道功能恢复时间。
方法
这是一项在单中心进行的前瞻性随机对照双盲研究。2021 年 11 月至 2022 年 4 月，内蒙古自治区兴安盟人民医院择期行良性腹腔镜妇科手术的所有患者连续纳入并随机分为阿片类药物节约型麻醉组（OS 组）和常规麻醉组（C 组）。分析两组患者术后首次排气时间、进食时间和术后恶心和/或呕吐（PONV）情况。
结果
本研究共纳入 71 例患者，其中 OS 组 35 例，C 组 36 例。两组患者一般情况、手术时间、手术类型、术中出血量、术中输液量和术中尿量比较，差异均无统计学意义。与 C 组相比，OS 组患者术后首次肛门排气时间（11[8，14]h 比 14[11，18]h，p=0.003）和麻醉复苏时间（7[6，9]h 比 9[7，11]h，p=0.013）明显缩短。OS 组 PONV 发生率明显低于 C 组（11.4%比 41.7%，p=0.007）。
结论
依托咪酯为基础的阿片类药物节约型麻醉方案可缩短妇科腹腔镜良性手术后患者的术后首次肛门排气时间，并降低 PONV 发生率。此外，依托咪酯的应用可能会降低患者术后阿片类药物的需求剂量。
试验注册
本研究在中国临床试验注册中心注册（注册号：ChiCTR2100052528，30/10/2021）。
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