超前艾司氯胺酮抑制瑞芬太尼诱发腹腔镜妇科手术患者术后痛觉过敏

Preemptive Esketamine Ameliorated Postoperative Hyperalgesia Induced by Remifentanil in Patients Undergoing Laparoscopic Gynaecological Surgery

目的探讨超前艾司氯胺酮对瑞芬太尼诱发腹腔镜妇科手术患者术后痛觉过敏的影响。方法ASA分级I或Ⅱ级,择期妇科腹腔镜手术患者60例按照随机数字表法随机分为2组(n=30):生理盐水+瑞芬太尼组(S+R组)、艾司氯胺酮+瑞芬太尼组(E+R组)。两组患者麻醉诱导前30 min时分别静脉注射艾司氯胺酮0.25 mg/kg或等容积生理盐水;两组静脉输注瑞芬太尼0.1~0.3μg/(kg·min);记录术后静态和动态VAS评分、机械痛敏阈值、机械痛敏面积、术后24 h内舒芬太尼使用、术后1 h内镇静评分及不良反应发生情况。结果与S+R组比较,E+R组患者术后2 h、18 h时静态和动态VAS评分降低,切口区域及臂内侧机械痛敏阈值升高,机械痛敏面积降低,首次使用舒芬太尼时间延长,PACU中以及离开PACU 0~6 h、6~12 h、12~18 h舒芬太尼用量降低(P<0.05,P<0.01)。结论超前艾司氯胺酮有效抑制瑞芬太尼诱发腹腔镜妇科手术患者术后痛觉过敏。

Objective To study effects of preemptive esketamine on postoperative hyperalgesia induced by remifentanil in patients undergoing laparoscopic gynaecological surgery.Methods Accoriding to ASA I or II,60 patients with elective gynecological laparoscopic surgery were randomly divided into 2 groups(n=30 each):saline+remifentanil group(group S+R),esketamine+remifentanil group(group E+R).At 30 mins before anesthesia induction,0.25 mg/kg esketamine or equal volume of physiological saline were injected intravenously.Intraoperative analgesia was maintained with infusion of remifentanil at 0.1~0.3μg/(kg·min),visual analogue scale(VAS)scores at rest and during activity,threshold and area of mechanical hyperalgesia,consumption of sufentanil and side-effects were recorded.Results Compared with group S+R,static and dynamic VAS scores of group E+R decreased at 2 h and 18 h after operation,mechanical hyperalgesia threshold in incision area and inner arm increased,mechanical hyperalgesia area decreased.Sufentanil was used for the first time for a longer time,and amount of sufentanil in the PACU and at 0~6 h,6~12 h,12~18 h after leaving the PACU decreased(P<0.05,P<0.01).Conclusion Preemptive esketamine effectively ameliorated hyperalgesia induced by remifentanil in patients undergoing laparoscopic gynaecological surgery.