艾司氯胺酮与舒芬太尼在宫腔镜术后镇痛中的相互作用及配伍方案优化

Interaction and optimization of compatibility between esketamine and sufentanil in postoperative analgesia after gynecological laparoscopy surgery

目的探究艾司氯胺酮与舒芬太尼在宫腔镜术后镇痛中的相互作用,并对配伍方案进行优化。方法选取2022年6月至2023年1月全麻下行妇科腹腔镜手术的患者80例,随机分为16组,每组5例,术后予艾司氯胺酮单次给药,舒芬太尼采用自控静脉镇痛(PCIA)方式给药。记录患者出手术室时,术后4、8、12、24 h的视觉模拟量表(VAS)评分、Ramsay镇静量表(RSS)评分,监测心率(HR)和平均动脉压(MAP)的变化,记录PCIA按压次数。利用响应曲面模型分析艾司氯胺酮和舒芬太尼之间的相互作用规律和最佳剂量配伍范围。结果响应曲面模型显示0.1~0.5 mg·kg^(-1)艾司氯胺酮和0.1~0.5μg·kg^(-1)舒芬太尼在宫腔镜术后镇痛中有协同作用。当舒芬太尼剂量为0.1μg·kg^(-1)时,艾司氯胺酮最佳剂量范围为0.29~0.43 mg·kg^(-1);当舒芬太尼剂量为0.2μg·kg^(-1)时,艾司氯胺酮最佳剂量范围为0.25~0.36 mg·kg^(-1);当舒芬太尼剂量为0.25μg·kg^(-1)时,艾司氯胺酮最佳剂量范围为0.17~0.23 mg·kg^(-1)。结论将舒芬太尼与艾司氯胺酮联合用于宫腔镜术后镇痛具有协同作用,在最佳剂量配伍范围内使用能够有效镇痛,且不会增加不良反应的发生率。

AIM To investigate the interaction and optimize the compatibility between esketamine and sufentanil in postoperative analgesia after gynecological laparoscopy surgery.METHODS A total of 80 patients undergoing gynecological laparoscopic surgery under general anesthesia from June 2022 to January 2023 were randomly divided into 16 groups,with 5 patients in each group.Postoperatively,a single dose of esketamine was administered,and sufentanil was delivered via patient-controlled intravenous analgesia(PCIA).The visual analogue scale(VAS)scores and Ramsay sedation scale(RSS)scores of the patients were recorded at the time of the patients'discharge from the operating room,and at 4,8,12 and 24 h after surgery.Changes in heart rate(HR)and mean arterial pressure(MAP)were monitored,and the number of PCIA presses was recorded.A response curve modeling approach was employed to analyze the interaction patterns and determine the optimal compatibility concentration range between esketamine and sufentanil.RESULTS The response curve model indicated a synergistic effect between esketamine(concentration range of 0.1-0.5 mg·kg^(-1))and sufentanil(concentration range of 0.1-0.5μg·kg^(-1))in postoperative analgesia following gynecological laparoscopy surgery.When sufentanil concentrations were 0.1μg·kg^(-1),0.2μg·kg^(-1) and 0.25μg·kg^(-1),the optimal concentration ranges for esketamine were 0.29-0.43 mg·kg^(-1),0.25-0.36 mg·kg^(-1),and 0.17-0.23 mg·kg^(-1) respectively.CONCLUSION The combination of esketamine and sufentanil for postoperative analgesia after hysteroscopic surgery demonstrates a synergistic effect.The use of these drugs within the optimal compatibility concentration range provides effective analgesia without increasing the incidence of adverse reactions.