Tang J, Yuan Y J, Guo Y H, Li W J, La J
Department of Anesthesiology, Affiliated Hospital of Qinghai University, Xining 810001, China.
Zhonghua Yi Xue Za Zhi. 2025 Jul 15;105(26):2244-2248. doi: 10.3760/cma.j.cn112137-20241228-02950.
To investigate the clinical anesthetic and analgesic effects of sub-anesthetic doses of esketamine in elderly patients with gastrointestinal tumors during the perioperative period in plateau areas, a prospective study was conducted to include elderly patients (≥60 years) undergoing laparoscopic radical resection of gastrointestinal tumors under general anesthesia at the Affiliated Hospital of Qinghai University from June 2023 to October 2024. They were randomly divided into an experimental group and a control group. The experimental group received an intravenous infusion of esketamine at 0.2 mg·kg⁻¹·h⁻¹ from 10 min before anesthesia induction until 10 min before the end of surgery, while the control group was administered an equal-volume infusion of normal saline at the same rate during the same period. The perioperative clinical data and differences in anesthesia and pain-related indicators at different time points were compared between the two groups. Finally, 67 patients were included for analysis, including 33 patients in the control group [23 males, aged (68.8±6.2) years] and 34 patients in the experimental group [24 males, aged (67.7±5.1) years]. There were no significant differences in age, gender, American Society of Anesthesiologists classification, and operation duration between the two groups (all >0.05). The mean arterial pressure in the experimental group was higher than that in the control group at 1 min of pneumoperitoneum and 30 min of extubation [(87.6±8.5) mmHg vs (81.7±8.8) mmHg; (95.6±10.3) mmHg vs (90.1±9.0) mmHg (1 mmHg=0.133 kPa), all <0.05]. The visual analog scale for pain in the experimental group was lower than that in the control group at 2, 12, and 24 h after surgery (all <0.05). The amount of propofol, remifentanil, norepinephrine, and fluid infusion in the experimental group were all lower than those in the control group (all <0.05), and the recovery time of spontaneous breathing [(8.6±2.6) min vs (13.4±4.1) min, <0.05] and the awakening time [(11.6±3.5) min vs (16.4±5.2) min, <0.05] were both shorter than those in the control group. This study suggests that in elderly patients with gastrointestinal tumors undergoing general anesthesia in plateau areas, the combination of sub-anesthetic doses of esketamine can improve the efficacy of anesthesia and analgesia without affecting recovery, and reduce the amount of other anesthetic drugs used.
为探讨亚麻醉剂量艾司氯胺酮对高原地区老年胃肠道肿瘤患者围手术期的临床麻醉及镇痛效果，本研究进行了一项前瞻性研究，纳入2023年6月至2024年10月在青海大学附属医院接受全身麻醉下腹腔镜根治性切除胃肠道肿瘤的老年患者（≥60岁）。将他们随机分为实验组和对照组。实验组在麻醉诱导前10分钟至手术结束前10分钟，以0.2mg·kg⁻¹·h⁻¹的速度静脉输注艾司氯胺酮，而对照组在同一时期以相同速度输注等体积的生理盐水。比较两组围手术期临床资料及不同时间点麻醉和疼痛相关指标的差异。最终纳入67例患者进行分析，其中对照组33例[男性23例，年龄（68.8±6.2）岁]，实验组34例[男性24例，年龄（67.7±5.1）岁]。两组患者的年龄、性别、美国麻醉医师协会分级及手术时长比较，差异均无统计学意义（均>0.05）。实验组在气腹1分钟和拔管30分钟时的平均动脉压高于对照组[（87.6±8.5）mmHg比（81.7±8.8）mmHg；（95.6±10.3）mmHg比（90.1±9.0）mmHg（1mmHg = 0.133kPa），均<0.05]。实验组术后2、12和24小时的视觉模拟疼痛评分低于对照组（均<0.05）。实验组丙泊酚、瑞芬太尼、去甲肾上腺素用量及液体输注量均低于对照组（均<0.05），自主呼吸恢复时间[（8.6±2.6）分钟比（13.4±4.1）分钟，<0.05]和苏醒时间[（11.6±3.5）分钟比（16.4±5.2）分钟，<0.05]均短于对照组。本研究表明，在高原地区接受全身麻醉的老年胃肠道肿瘤患者中，亚麻醉剂量艾司氯胺酮联合使用可提高麻醉和镇痛效果，且不影响恢复，并减少其他麻醉药物的用量。
