Zhang Jing, Niu Zheng, Wang Ting, Yu Lianya, Ren Xinyi, Zhang Shurui, Zhu Yuwei, Qi Dunyi
Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China.
Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.
Perioper Med (Lond). 2025 Jul 23;14(1):78. doi: 10.1186/s13741-025-00567-z.
To investigate the effect of intraoperative low-dose esketamine administered at anesthesia induction on postoperative quality of recovery in total laparoscopic hysterectomy.
One-hundred six female patients scheduled for elective total laparoscopic hysterectomy were randomly divided into saline group (group P) and esketamine group (group S). Group P received induction with normal saline, propofol, sufentanil, midazolam, and rocuronium, while group S received induction with low-dose esketamine (0.25 mg/kg), propofol, sufentanil, midazolam, and rocuronium. Both groups were maintained with intravenous infusions of propofol and remifentanil. The quality of recovery (QoR-40), Numerical Rating Scale (NRS), and Pittsburgh Sleep Index (PSQI) scores were assessed at 8, 24, 48, and 72 h, 7 days, and 30-day post-surgery. Hamilton Depression Scale (HAMD) scores were evaluated at 72 h, 7 days, and 30-day post-surgery. Intraoperative hemodynamics, remifentanil consumption, inflammatory reactions, and adverse reactions were also documented.
Both groups had similar QoR-40 scores at each time point (P > 0.05). Patients in group S had less intraoperative remifentanil use (P < 0.001), less consumption of phenylephrine (P = 0.005), fewer episodes of hypotension (P < 0.001), and shorter extubation time and stay in postanesthesia care unit (PACU) (P < 0.001). The NRS scores after extubation (P = 0.007), 8 h (P = 0.027) and 48 h (P = 0.016) after surgery, and the postoperative NLR (P = 0.003) and postoperative 24-h PSQI score (P = 0.024) were significantly lower in group S. The mean blood pressure (MBP) was higher at 10 min after incubation (T3) (P < 0.001). The heart rate (HR) was faster at 3 min (T1) (P = 0.005), 10 min (T3) (P = 0.023), and 30 min (T4) (P = 0.014) after incubation and complete end of surgery (T5) (P = 0.010) in group S. Multiple linear regression analyses demonstrated that higher education was associated with better recovery (P < 0.05).
In patients undergoing total laparoscopic hysterectomy, one injection of low-dose esketamine at anesthesia induction did not affect QoR-40 scores. However, esketamine stabilized intraoperative hemodynamics, decreased intraoperative opioid requirements, and shortened postoperative extubation time and PACU stay. It also alleviated postoperative inflammatory response and pain without causing adverse effects.
探讨麻醉诱导期给予术中低剂量艾司氯胺酮对全腹腔镜子宫切除术患者术后恢复质量的影响。
106例择期行全腹腔镜子宫切除术的女性患者随机分为生理盐水组（P组）和艾司氯胺酮组（S组）。P组患者诱导用药为生理盐水、丙泊酚、舒芬太尼、咪达唑仑和罗库溴铵，而S组患者诱导用药为低剂量艾司氯胺酮（0.25mg/kg）、丙泊酚、舒芬太尼、咪达唑仑和罗库溴铵。两组均采用丙泊酚和瑞芬太尼静脉输注维持麻醉。分别于术后8、24、48和72小时、7天及30天评估恢复质量（QoR-40）、数字评分量表（NRS）及匹兹堡睡眠指数（PSQI）评分。于术后72小时、7天及30天评估汉密尔顿抑郁量表（HAMD）评分。记录术中血流动力学、瑞芬太尼用量、炎症反应及不良反应。
两组在各时间点的QoR-40评分相似（P＞0.05）。S组患者术中瑞芬太尼用量较少（P＜0.001），去氧肾上腺素用量较少（P = 0.005），低血压发作次数较少（P＜0.001），拔管时间及在麻醉后恢复室（PACU）的停留时间较短（P＜0.001）。S组拔管后（P = 0.007）、术后8小时（P = 0.027）和48小时（P = 0.016）的NRS评分以及术后中性粒细胞与淋巴细胞比值（NLR）（P = 0.003）和术后24小时PSQI评分（P = 0.024）显著较低。给药后10分钟（T3）时平均血压（MBP）较高（P＜0.001）。S组在给药后3分钟（T1）（P = 0.005）、10分钟（T3）（P = 0.023）、30分钟（T4）（P = 0.014）及手术结束时（T5）（P = 0.010）心率较快。多元线性回归分析表明，受教育程度较高与恢复较好相关（P＜0.05）。
在接受全腹腔镜子宫切除术的患者中，麻醉诱导期单次注射低剂量艾司氯胺酮不影响QoR-40评分。然而，艾司氯胺酮可稳定术中血流动力学，降低术中阿片类药物需求量，缩短术后拔管时间及在PACU的停留时间。它还可减轻术后炎症反应和疼痛，且无不良反应。
