艾司氯胺酮不同时机给药对瑞芬太尼痛觉过敏的影响

Effects of Esketamine Administered at Different Time Points on Remifentanil-Induced Hyperalgesia

目的观察艾司氯胺酮不同时机给药对瑞芬太尼致腹腔镜全子宫切除术后痛觉过敏的影响。方法选择全身麻醉下行腹腔镜全子宫切除术患者90例,随机分为3组,每组30例。A组切皮前静推艾司氯胺酮0.25 mg/kg,缝皮前20 min静推2 mL生理盐水;B组切皮前静推生理盐水2 mL,缝皮前20 min静推艾司氯胺酮0.25 mg/kg;C组切皮前静推生理盐水2 mL,缝皮前20 min静推生理盐水2 mL。采用电子压力测痛仪测定患者切口周围及前臂术前、术后6 h、12 h、24 h和48 h的疼痛阈值;采用疼痛数字评分(numerical rating scale,NRS)评估患者术后30 min、2 h、6 h、12 h、24 h、48 h的疼痛程度;采用警觉镇静评分(observer assessment of sedation,OAAS)评估患者拔管后5 min的意识状态;记录各组术后拔管时间、术后曲马多使用情况及不良事件发生情况。结果切口周围和前臂的疼痛阈值检测均显示:术前痛阈三组间差异无统计学意义;术后6 h、12 h、24 h的痛阈,B组高于A、C组,A组高于C组,差异均有统计学意义(P<0.05);术后48 h痛阈三组间差异无统计学意义;术后各时点痛阈均低于术前。术后30 min、2 h、6 h、12 h、24 h、48 h的NRS评分比较,A、C组高于B组,差异有统计学意义(P<0.05);A组和C组差异无统计学意义。拔管后5 min的OAAS评分比较,B组的镇静程度高于A、C组,差异有统计学意义(P<0.05);A组和C组差异无统计学意义。与B组比较,A、C组患者术后首次要求追加曲马多的时间明显提前(P<0.05),累积用量增多(P<0.05),镇痛次数增多(P<0.05),A组和C组差异无统计学意义。结论艾司氯胺酮对瑞芬太尼诱发的痛觉过敏有一定的预防作用,且相比于切皮前给予,术毕前给予艾司氯胺酮预防效果更为明显。

Objective To observe the effects of esketamine administered at different time points on remifentanil-induced hyperalgesia.Methods Ninety patients undergoing laparoscopic total hysterectomy under general anesthesia were randomly divided into 3 groups with 30 patients in each.In group A,0.25 mg/kg esticketamine was intravenously injected before skin incision,and 2 mL normal saline was intravenously injected 20 minutes before skin suture.In group B,2 mL normal saline was intravenously injected before skin incision and 0.25 mg/kg esketamine was intravenously injected 20 minutes before skin suture.In group C,2 mL normal saline was intravenously injected before skin excision and 2 mL normal saline was intravenously injected 20 minutes before skin suture.The pain thresholds around the incision and forearm were measured pre-operatively,and 6 h,12 h,24 h and 48 h postoperatively by electronic pressure meter.Numerical rating scale(NRS)was used to evaluate the degree of pain at 30 min,2 h,6 h,12 h,24 h and 48h postoperatively.Observer assessment of sedation(OAAS)was used to evaluate the patients'state of consciousness 5 minutes after extubation.Postoperative extubation time,postoperative diclofenac sodium suppository use and adverse events were compared among the three groups.Results There was no significant difference in preoperative pain threshold among the three groups.The pain threshold at 6 h,12 h and 24 h after surgery of group B was higher than that of group A and C,while group A was higher than group C(P<0.05).There was no significant difference in pain threshold 48h after operation among the three groups.The pain threshold at all postoperative points was lower than the preoperative baseline.NRS of 30 min,2 h,6 h,12 h,24 h and 48 h after operation of group A and C was higher than that of group B(P<0.05),while there was no significant difference between group A and C.5-minute post-extubation OAAS scores were compared among three groups,and the sedation degree of group B was higher than that of group A and C(P<0.05).There was no significant difference between group A and group C.Compared with group B,time of first postoperative request for additional diclofenac sodium suppository in group A and group C was significantly earlier(P<0.05),the cumulative dosage increased(P<0.05),and the number of repeated requests for analgesia increased as well(P<0.05).Conclusion Esselketamine has a certain preventive effect on hyperalgesia induced by remifentanil,and compared with the administration before skin resection,the administration of esselketamine before skin suture can relieve the allodynia move obviously.