艾司氯胺酮联合右美托咪定对瑞芬太尼痛觉过敏的影响

Effects of esketamine combined with dexmedetomidine on remifentanil-induced acute postoperative hyperalgesia

为了探讨小剂量艾司氯胺酮联合右美托咪定对瑞芬太尼全身麻醉后痛觉过敏的影响,文章择期全身麻醉下行肺癌根治术患者80例,随机分成A,B,C,D 4组,每组20例,对照组为A组,艾司氯胺酮组为B组,右美托咪定组为C组,艾司氯胺酮联合右美托咪定组为D组。4组患者均输注异丙酚和瑞芬太尼进行麻醉诱导和维持,术后给予舒芬太尼自控镇痛。记录4组患者手术时间、出血量、术毕恢复情况(苏醒时间、拔管时间),术后0.5 h(T_(1)),1 h(T_(2)),2 h(T_(3)),4 h(T_(4)),24 h(T5)的VAS评分,术后24 h内镇痛药用量,术后24 h内PCA自控按压次数,术后不良反应发生情况。结果显示,4组患者身高、体质量、年龄、体质量指数、手术时间、术中出血量、苏醒时间、拔管时间相比差异无统计学意义(P<0.05);4组患者术后不同时点VAS评分的比较,A组与B组、C组、D组比较差异有统计学意义(P<0.05),B组与C组比较差异无统计学意义(P>0.05),D组与A组、B组、C组比较差异有统计学意义(P<0.05);4组患者术后24 h镇痛药用量、术后24 h镇痛泵按压次数的比较,A组与B组、C组、D组比较差异有统计学意义(P<0.05),B组与C组比较差异无统计学意义(P>0.05),D组与A组、B组、C组比较差异有统计学意义(P<0.05);4组患者术后不良反应发生情况相比差异无统计学意义(P>0.05)。研究表明,小剂量艾司氯胺酮联合右美托咪定能够有效预防瑞芬太尼全身麻醉后引起的痛觉过敏,不增加术毕恢复时间,减少术后24 h镇痛药物用量,减少术后24 h PCA自控按压次数,降低术后0.5 h,1 h,2 h,4 h和24 h的VAS评分,并且不增加术后不良反应的发生。

To investigate the effects of low-dose ketamine combined with dexmedetomidine on remifentanil-induced acute postoperative hyperalgesia,80 patients for selective radical resection of pulmonary carcinoma were randomly divided into A,B,C and D groups,with 20 subjects in each group in this paper.Group A was contrast group,Group B was ketamine group,Group C was dexmedetomidine group,Group D was ketamine combined with dexmedetomidine group.Operation time,bleeding volume,recovery situation was recorded,0.5 h,1 h,2 h,4 h and 24 h VAS score after operation,consumption of analgesics within 24 h after operation,PCA pressing times within 24 h after operation were recorded,and adverse reaction were also recorded.The results showed that there are no significant difference in height,body mass,age,body mass index,operative lasting time,amount of bleeding,recovery time,extubation time between four groups.VAS score after operation,Group A compared with Group B,Group C and Group D,there were significant difference in statistically(P<0.05),Group B compared with Group C,there was no significant difference(P>0.05),Group D compared with Group A,B and C,there was significant difference(P<0.05);consumption of analgesic and analgesia pump pressing times within 24 h after operation,Group A compared with Group B,C and D,there were significant difference in statistically(P<0.05),Group B compared with Group C,there was no significant difference(P>0.05),Group D compared with Group A,B and C,there was significant difference(P<0.05);adverse reactions between four groups,there were no significant difference after operation(P>0.05).Low dose of ketamine combined with dexmedetomidine can effectively prevent hyperalgesia caused by remifentanil,not increase the recovery time,reduce the consumption of analgesics,reduce the pressing times of PCA,reduce 0.5 h,1 h,2 h,4 h and 24 h VAS score after operation,and not increase the incidence of postoperative adverse reactions.