小剂量氯胺酮联合舒芬太尼对食管癌患者术后疼痛评分及血浆β-内啡肽水平的影响

Effect of small dose ketamine combined with sufentanil on pain score and plasma levels of β-endorphin in postoperative patients with esophageal cancer

目的:观察小剂量氯胺酮联合舒芬太尼对食管癌患者术后疼痛评分以及血浆β-内啡肽水平的影响。方法:选择行全麻下食管癌根治术患者120例,按随机数字表法分为A、B、C 3组,每组40例。A组给予舒芬太尼2μg·kg^(-1)·h^(-1),B组给予舒芬太尼2.5μg·kg^(-1)·h^(-1),C组给予舒芬太尼2μg·kg^(-1)+氯胺酮90μg·kg^(-1)·h^(-1),观察比较3组术后6、12、24、48 h疼痛视觉模拟评分(VAS)、并发症、自控静脉镇痛泵(PICA)按压次数及血浆β-内啡肽水平。结果:术后6、12、24、48 h疼痛VAS B组、C组均显著低于A组(P<0.05),C组显著低于B组(P<0.05);术后48 h内并发症发生率、PICA按压次数B组、C组均显著少于A组(P<0.05),C组显著少于B组(P<0.05);术后6、12、24、48 h血浆β-内啡肽B组显著低于A组(P<0.05);C组显著高于A组(P<0.05)。结论:小剂量氯胺酮联合舒芬太尼对食管癌患者镇痛效果良好,可提高体内血浆β-内啡肽,并显著降低其术后并发症发生率,值得临床推广。

Objective： To observe the effect of small dose ketamine combined with sufentanil on pain score and plasma levels of β-endorphin in esophageal carcinoma patients after radical operation. Methods： One hundred and twenty cases of esophageal carcinoma who were treated with radical resection under general anesthesia were randomly divided into group A（ n = 40）,B（ n = 40）,C（ n = 40）. Group A was given sufentanil 2 μg·kg-（-1）·h-（-1）; group B received sufentanil 2. 5 μg·kg-（-1）·h-（-1）; group C was given sufentanil 2 μg ·kg-（-1）·h-（-1）and ketamine 90 μg · kg-（-1）· h-（-1）. Pain visual simulation score（ VAS）,complications,pressing times of patient controlled intravenous analgesia（ PICA） and levels of β-endorphin were compared between the three groups at 6,12,24,48 h after operation. Results： VAS scores in group B and group C were significantly lower than that in group A（ P〈0. 05） 6,12,24,48 h after operation,while VAS scores in group C was significantly lower than that in group B（ P〈0. 05）. The occurrence rate of complications within 48 h,pressing times of PICA in group B and group C were significantly lower than those in group A（ P〈0. 05）,and group C was significantly lower than those in group B（ P〈0. 05）. β-endorphin in group B was significantly lower than that in group A（ P〈0. 05）,and β-endorphin in group C was significantly higher than that in group A（ P〈0. 05）. Conclusion： Small dose ketamine combined with sufentanil has a good analgesic effect,it can improve the plasma levels of β-endorphin and significantly reduce the postoperative complications. It is worth a clinical application.