不同剂量艾司氯胺酮复合舒芬太尼用于食管癌术后患者自控静脉镇痛的效果

Effect of different doses of esketamine with sufentanil on patient-controlled intravenous analgesia after esophageal cancer surgery

目的观察不同剂量艾司氯胺酮复合舒芬太尼用于食管癌术后患者自控静脉镇痛(PCIA)的效果及对炎症因子的影响。方法将拟行食管癌根治术的90例患者随机分为S1组、SE1组、SE2组,每组30例。3组麻醉诱导和维持方案相同,术后均采用PCIA。镇痛液配方S1组为舒芬太尼2μg·kg^(-1)+托烷司琼10 mg+氯化钠注射液至100 mL,SE1组、SE2组在S1组基础上分别加用艾司氯胺酮0.015、0.03 mg·kg^(-1)·h^(-1)。初始负荷剂量均为5 mL,背景输注剂量2 mL·h^(-1),单次按压量2 mL,极限量12 mL,锁定时间15 min。评估术后4、8、24、48 h的疼痛视觉模拟量表(VAS)评分,记录术后48 h内镇痛泵按压次数。采用酶联免疫吸附法检测麻醉前、术毕、术后48 h时血清白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α浓度,并观察不良反应发生情况。结果术后4、8、24、48 h,SE1组和SE2组疼痛VAS评分均低于S1组,且SE2组低于SE1组,差异均有显著意义(P<0.05)。术后48 h内,SE1组和SE2组PCIA泵按压次数少于S1组(P<0.05),且SE2组少于SE1组(P<0.05)。与麻醉前相比,3组术毕、术后48 h时IL-6、TNF-α水平均上升(P<0.05),麻醉前、术毕3组IL-6、TNF-α水平比较无显著差异(P>0.05),术后48 h时SE1组、SE2组IL-6、TNF-α水平均低于S1组(P<0.05),且SE2组低于SE1组(P<0.05)。3组不良反应发生率比较无显著差异(P>0.05)。结论食管癌术后艾司氯胺酮复合舒芬太尼PCIA能提供良好的镇痛效果,且能降低术后炎症因子水平,艾司氯胺酮0.03 mg·kg^(-1)·h^(-1)为推荐剂量。

AIM To observe the effect of different doses of esketamine with sufentanil on the postoperative patientcontrolled intravenous analgesia(PCIA)of esophageal cancer and its effect on inflammatory factors.METHODS Ninety patients who planned to undergo radical esophagectomy were randomly divided into group S1,group SE1 and group SE2,with 30 cases in each group.The induction and maintenance of anesthesia in 3 groups were the same,and PCIA was used after operation.The formula of analgesia solution in the group S1 was sufentanil 2μg·kg^(-1)+tropisetron 10 mg+sodium chloride injection to 100 mL,and in the group SE1 and group SE2 were added with esketamine 0.015 and 0.03 mg·kg^(-1)·h^(-1) respectively on the basis of the group S1.The initial loading dose was 5mL,the background infusion dose was 2 mL·h^(-1),the single pressing dose was 2 mL,the maximum limit was 12 mL,and the locking time was 15 min.Visual analogue scale(VAS)score of pain was estimated at 4,8,24 and 48 h after operation,and the number of analgesic pump compression were recorded within 48 h after operation.The concentrations of serum interleukin(IL)-6 and tumor necrosis factor(TNF)-αwere measured by enzyme-linked immunosorbent assay before anesthesia,at the end of operation and 48 h after operation,and the adverse reactions were observed.RESULTS The VAS score in the group SE1 and group SE2 were lower than that in the group S1,and that in the group SE2 was lower compared with the group SE1 at 4,8,24,48 h after surgery,the differences were significant(P<0.05).Within 48 h after operation,the number of PCIA pump compression in the group SE1 and group SE2 was less than that the in group S1,and that in group SE2 was less compared with group SE1(P<0.05).Compared with those before anesthesia,the levels of IL-6 and TNF-αwere increased at the end of operation and 48h after operation in3 groups,and there was no significant difference in the levels of IL-6 and TNF-αamong 3 groups before anesthesia and at the end of operation(P>0.05).The levels of IL-6 and TNF-αin group SE1 and group SE2 were lower than those in the group S1,and those in the group SE2 were lower compared with the group SE1 at 48 h after operation(P<0.05).There was no significant difference in the incidence of adverse reactions among 3 groups(P>0.05).CONCLUSION Esketamine combined with sufentanil PCIA can provide better analgesic effect and reduce the level of postoperative inflammatory factors,and 0.03 mg·kg^(-1)·h^(-1) is the recommended dose of esketamine.