摘要目的:探讨艾司氯胺酮介导的阿片节俭策略（OSS）对腹腔镜子宫全切术患者术后恶心呕吐（PONV）发生率的影响。方法:择期行全麻下腹腔镜子宫全切术的患者78例，按随机数字表法分为艾司氯胺酮组（E组，40例）和对照组（C组，38例）。E组行全麻及竖脊肌平面阻滞（ESPB），并于麻醉诱导（0.15 mg/kg）、麻醉维持（0.15 mg·kg?1·h?1）及术后患者自控镇痛（1 mg/kg）中额外使用艾司氯胺酮；C组则在相同全麻与ESPB操作下，于对应环节给予等剂量生理盐水。记录两组患者一般情况及术中瑞芬太尼、丙泊酚用量；在麻醉后监测治疗室（PACU）时、术后6 h、术后24 h时的PONV发生率、严重程度及补救止吐率，术后24 h内PONV总发生率和胃复安用量；麻醉诱导前（T 0）、麻醉诱导后（T 1）、阻滞后（T 2）、切皮时（T 3）、气腹后1 min（T 4）、气腹后30 min（T 5）和手术结束时（T 6）的平均动脉压和心率；出PACU时和术后6、12、24、48 h的数字分级评分法（NRS）疼痛评分；术后48 h内镇痛泵按压次数及舒芬太尼用量、补救镇痛率；术后睁眼时间、拔管时间、首次肛门排气时间、术后住院时间和40项恢复质量评分量表（QoR-40）评分。 结果:与C组比较，E组术中瑞芬太尼用量、术后24 h内甲氧氯普胺用量、术后48 h内镇痛泵按压次数及舒芬太尼用量较少（均 P<0.05），在PACU时PONV发生率、术后24 h 内PONV总发生率较低（均 P<0.05），术后首次肛门排气时间较短（ P<0.05）。两组患者其他指标差异均无统计学意义（均 P>0.05）。 结论:艾司氯胺酮介导的OSS能在维持术中血流动力学稳定的同时，降低术中和术后阿片类药物用量，从而降低腹腔镜子宫全切术PONV的发生率。

abstractsObjective:To investigate the effects of the esketamine-mediated opioid-sparing strategy (OSS) on postoperative nausea and vomiting (PONV) after total laparoscopic hysterectomy.Methods:A total of 78 patients scheduled for total laparoscopic hysterectomy under general anesthesia were selected. According to the random number table method, patients were divided into the esketamine group (group E, n=40) or the control group (group C, n=38). Both groups received general anesthesia combined with ultrasound-guided erector spinae plane block (ESPB). Additionally, group E received esketamine at a dose of 0.15 mg/kg during anesthesia induction, 0.15 mg·kg?1·h?1 during anesthesia maintenance, and 1 mg/kg in postoperative patient-controlled analgesia; whereas group C was given an equal volume of normal saline at the corresponding stages under the same general anesthesia and ESPB procedure. Record the following parameters in both groups: general patient characteristics, intraoperative consumption of remifentanil and propofol; incidence, severity of PONV as well as rescue antiemetic rate in the post-anesthesia care unit (PACU), at 6 h and 24 h postoperatively, total incidence of PONV within 24 h postoperatively, and dosage of metoclopramide; mean arterial pressure and heart rate before anesthesia induction (T 0), after anesthesia induction (T 1), after nerve block (T 2), at skin incision (T 3), at 1 min after pneumoperitoneum (T 4), and at 30 min after pneumoperitoneum (T 5), and at the end of surgery (T 6); Numerical Rating Scale (NRS) scores at discharge from PACU and at 6 h, 12 h, 24 h, 48 h postoperatively; dosage of sufentanil in the analgesic pump, number of pump presses, and rescue analgesia rate within 48 h postoperatively; postoperative eye-opening time, extubation time, time to first flatus, postoperative hospital stay, and Quality of Recovery-40 (QoR-40) score. Results:Compared with group C, the dosage of intraoperative remifentanil, dosage of metoclopramide within 24 h postoperatively, number of analgesic pump presses and dosage of sufentanil within 48 h postoperatively in group E were decreased (all P<0.05); the incidence of PONV in the PACU and the total incidence of PONV within 24 h postoperatively in group E were reduced (all P<0.05); and the time to first flatus in group E was shortened ( P<0.05). There were no statistically significant differences in other indicators between the two groups (all P>0.05). Conclusions:Esketamine-mediated opioid-sparing strategy could reduce intraoperative and postoperative opioid consumption while maintaining stable intraoperative hemodynamics, thereby decreasing the incidence of PONV in total laparoscopic hysterectomy.