低剂量艾司氯胺酮应用于肝癌手术辅助镇痛策略

Application of low-dose esketamine in assisted analgesia strategy for liver cancer surgery

目的评价低剂量艾司氯胺酮应用于肝癌手术辅助镇痛的有效性和安全性。方法抽取2020年10月至2022年5月于郑州大学附属肿瘤医院行择期肝癌切除术的患者80例,按照随机数字表法将其分为艾司氯胺酮组(ES组)和生理盐水对照组(NS组),每组40例。记录并比较两组患者手术时间、苏醒及拔管时间、术中舒芬太尼用量,统计患者离开麻醉恢复室(T0)及返回病房1 h(T1)、4 h(T2)、8 h(T3)、12 h(T4)、24 h(T5)的视觉模拟评分法(VAS)评分,记录术后24 h镇痛泵按压次数、补救镇痛例数、谵妄和恶心呕吐发生情况。结果两组各剔除1例,最终每组纳入39例。两组手术时间、苏醒及拔管时间、谵妄发生率、恶心呕吐发生率、镇痛泵按压次数、补救镇痛比例比较,差异未见统计学意义(P>0.05)。ES组术中及术后舒芬太尼总量少于NS组(t=10.55,P<0.05)。ES组术后各时间点(T0~T5)VAS评分均低于NS组(t=2.35、2.53、2.42、2.49、2.51、2.29,P均<0.05)。结论低剂量艾司氯胺酮可安全用于肝癌手术麻醉并辅助术后镇痛,具有阿片类药物节约效应。

Objective To evaluate the safety and efficacy of low-dose esketamine in assisted analgesia stategy for liver cancer surgery.Methods A total of 80 patients who underwent elective liver cancer resection in Affiliated Cancer Hospital of Zhengzhou University from October 2020 to May 2022 were selected,and the patients were divided into esketamine group(ES group)and normal saline control group(NS group)according to the random number table method,with 40 cases in each group.The operation time,recovery and extubation time,intraoperative sufentanil dosage of the two groups were recorded and compared,the visual analogue scale(VAS)score of the patients at leaving the anesthesia recovery room(T0)and returning to the ward for 1 hour(T1),4 hours(T2),8 hours(T3),12 hours(T4),and 24 hours(T5)were counted;the frequency of analgesic pump pressing,rescue analgesia cases,incidence of delirium,incidence of nausea and vomiting 24 hours after operation were recorded.Results One case was excluded from each group,finally,39 cases were included in each group.There was no significant difference between the two groups in operation time,recovery and extubation time,incidence of delirium,incidence of nausea and vomiting,frequency of analgesic pump pressing,and proportion of salvage analgesia(P>0.05).The total dosage of sufentanil during and after operation in the ES group was less than that in the NS group(t=10.55,P<0.05).The VAS scores at each time point(T0 to T5)after operation in the ES group were lower than those in the NS group(t=2.35,2.53,2.42,2.49,2.51,2.29;all P<0.05).Conclusions Low-dose esketamine is safe in anesthesia and postoperative auxiliary analgesia in liver cancer surgery,and has an opioid-saving effect.