艾司氯胺酮对经尿道前列腺电切术老年患者术后镇痛效果及认知功能的影响

Effects of esketamine on postoperative analgesia and cognitive function in elderly patients undergoing transurethral resection of prostate

目的:观察艾司氯胺酮对经尿道前列腺电切术(TURP)患者术后镇痛效果及认知功能的影响。方法:选择在腰硬联合麻醉下行TURP的患者50例,随机分为舒芬太尼组和艾司氯胺酮组,每组25例。所有患者术后均行自控静脉镇痛(PCIA),舒芬太尼组镇痛泵配方为舒芬太尼2μg/kg+氯化钠注射液至100 mL,艾司氯胺酮组镇痛泵配方为艾司氯胺酮2 mg/kg+氯化钠注射液至100 m L。比较两组患者术后6 h、12 h、24 h、48 h疼痛视觉模拟(VAS)评分和Ramsay镇静评分,以及术后0~6 h、6~12 h、12~24 h、24~48 h镇痛药使用例数。比较两组患者术前1 d及术后1 d、3 d蒙特利尔认知评估量表(MoCA)评分,记录不良反应发生情况。结果:两组患者术后4个时点VAS评分均逐渐降低且组内比较差异有统计学意义(P<0.05)。术后6 h、12 h、24 h,艾司氯胺酮组VAS评分低于舒芬太尼组,Ramsay镇静评分高于舒芬太尼组(均P<0.05)。两组患者术后镇痛药物使用率比较,差异无统计学意义(P>0.05)。两组患者MoCA评分及术后48 h内不良反应发生率比较,差异均无统计学意义(均P>0.05)。结论:艾司氯胺酮用于TURP患者PCIA术后镇痛效果较好,对患者术后认知功能没有影响,且不增加不良反应的发生。

Objective: To observe the effects of esketamine on postoperative analgesia and cognitive function in patients undergoing transurethral resection of the prostate(TURP). Methods: Fifty patients who underwent TURP under combined spinal-epidural anesthesia were selected and randomly divided into sufentanil and esketamine groups, with 25 patients in each group. All patients underwent self-administered intravenous analgesia(PCIA) after surgery, and the analgesic pump formulation was sufentanil 2 μg/kg + sodium chloride injection to100 mL for the sufentanil group and esketamine 2 mg/kg+sodium chloride injection to 100 mL for the esketamine group. The visual analogue scale(VAS) scores and Ramsay sedation scores at 6 h, 12 h, 24 h, 48 h postoperatively as well as the amount of analgesic used from 0 to 6 h, from 6 to 12 h, from 12 to 24 h and from 24 to 48 h after surgery were compared between the two groups. The Montreal Cognitive Assessment(MoCA) scores were compared between the two groups 1 d before and 1 d and 3 d after surgery, and the occurrence of adverse reactions was recorded. Results: The VAS scores gradually decreased at the four postoperative time points in both groups and the differences were statistically significant(P<0.05). At 6 h, 12 h and 24 h after surgery, the VAS score of the esketamine group was lower than that of the sufentanil group, and the Ramsay sedation score of the esketamine group was higher than that of the sufentanil group(all P<0.05). There was no statistically significant difference in the rate of postoperative analgesic drug use between the two groups(P>0.05). When comparing the MoCA scores and the incidence of adverse reactions within 48 h after surgery between the two groups,the differences were not statistically significant(all P>0.05). Conclusion: The use of esketamine for postoperative PCIA in patients undergoing TURP is effective. What’s more, it has no effect on patients’ postoperative cognitive function, and does not increase the occurrence of adverse reactions.