艾司氯胺酮联合腹横筋膜阻滞对妇科腹腔镜 手术患者术后疼痛及恢复质量的影响

Effects of Esketamine Combined with Transversus Abdominis Plane Block on Postoperative Pain and Quality of Recovery in Patients Undergoing Gynecologic Laparoscopic Surgery

摘要: 目的：探讨艾司氯胺酮联合腹横筋膜(TAP)阻滞对妇科腹腔镜手术患者术后疼痛及术后恢复质量的影响。方法：选取2024年2月~2026年4月期间接诊的120例妇科腹腔镜手术患者，通过随机数字表法分为2组，各60例。对照组采用全凭静脉麻醉方案，观察组以艾司氯胺酮联合TAP阻滞麻醉。比较两组患者血压与心率变化、术后疼痛程度、苏醒质量、术后康复时间、炎症因子及不良反应。结果：入室时两组患者的平均动脉压、心率差异小(P > 0.05)；切皮时、手术15 min、手术结束即刻观察组平均动脉压、心率更高(P < 0.05)。手术后2 h、手术后6 h、手术后12 h、手术后24 h观察组视觉模拟评分法(VAS)的评分相较对照组更低(P < 0.05)。观察组警觉性评估/镇静量表(OAA/S)评分在术毕即刻、术后30 min时高于对照组(P < 0.05)。观察组下床活动时间、排气时间、术后出院时间均早于对照组(P < 0.05)。手术治疗前两组C反应蛋白(CRP)、肿瘤坏死因子-α (TNF-α)比较差异小(P > 0.05)；手术治疗后两组患者CRP、TNF-α均上升，且观察组上升幅度更小(P < 0.05)。观察组恶心呕吐、皮肤瘙痒、腹泻便秘发生率低于对照组(P < 0.05)。结论：艾司氯胺酮联合TAP阻滞在妇科腹腔镜手术中不仅可以保持稳定的血压、心率。相较全凭静脉麻醉还能减轻术后疼痛，提升苏醒质量，缩短术后康复时间，并且麻醉药物相关不良反应少。

Abstract: Objective: To explore the effect of esketamine combined with transverse fascia of abdomen (TAP) block on postoperative pain and recovery quality of patients undergoing gynecological laparoscopic surgery. Methods: 120 cases of gynecological laparoscopic surgery from February 2024 to April 2026 were selected and randomly divided into two groups, 60 cases in each group. The control group was given total intravenous anesthesia scheme, while the observation group was given esketamine combined with TAP block anesthesia. The changes of blood pressure and heart rate, postoperative pain, quality of recovery, postoperative rehabilitation time, inflammatory factors and adverse reactions were compared between the two groups. Result: There was little difference in mean arterial pressure and heart rate between the two groups (P > 0.05). The average arterial pressure and heart rate in the observation group were higher at the time of skin incision, 15 min after operation and immediately after operation (P < 0.05). The scores of visual analogue scale (VAS) in the observation group at 2 h, 6 h, 12 h and 24 h after operation were lower than those in the control group (P < 0.05). The score of OAA/S in the observation group was higher than that in the control group immediately after operation and 30 min after operation (P < 0.05). The time of getting out of bed, exhausting time and postoperative discharge time in the observation group were earlier than those in the control group (P < 0.05). C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) in the two groups had little difference before operation (P > 0.05). After surgical treatment, CRP and TNF-α in both groups increased, and the increase in the observation group was even smaller (P < 0.05). The incidence of nausea and vomiting, skin itching, diarrhea and constipation in the observation group was lower than that in the control group (P < 0.05). Conclusion: Esketamine combined with TAP block can not only maintain stable blood pressure and heart rate in gynecological laparoscopic surgery. Compared with total intravenous anesthesia, it can also reduce postoperative pain, improve the quality of awakening, shorten postoperative rehabilitation time, and have fewer adverse reactions related to narcotic drugs.