小剂量艾司氯胺酮复合舒芬太尼在脊柱矫形术后持续静脉镇痛中的应用

Application of low-dose esketamine combined with sufentanil in continuous intravenous analgesia after spinal orthopedic surgery

目的探讨小剂量艾司氯胺酮复合舒芬太尼在脊柱矫形术后持续静脉镇痛中的应用效果。方法选择2020年6月至2021年6月择期行脊柱矫形术患者36例,男18例,女18例,年龄18~64岁,BMI 17~29 kg/m^(2),ASAⅠ—Ⅲ级。采用完全随机设计法将患者分为两组:艾司氯胺酮复合舒芬太尼组(ES组)和单纯舒芬太尼组(S组),每组18例。ES组静注艾司氯胺酮0.25 mg/kg复合舒芬太尼1.5μg/kg行PCIA,S组静注舒芬太尼2μg/kg行PCIA。记录术后2、4、8、12、24、48、72 h静息和活动时NRS评分和Ramsay镇静评分。记录PCIA总按压次数、有效按压次数、PCIA中舒芬太尼总用量。记录术后住院时间、术后0~24、24~48、48~72 h头晕、恶心呕吐、尿潴留等不良反应发生情况。结果与S组比较,ES组术后2、4、8、12、24、48、72 h静息和活动时NRS评分明显降低(P<0.05),术后2、4、8、12 h Ramsay镇静评分明显升高(P<0.05),PCIA总按压次数、有效按压次数、PCIA中舒芬太尼总用量明显减少(P<0.05),术后0~24 h恶心呕吐发生率明显降低(P<0.05)。结论小剂量艾司氯胺酮复合舒芬太尼用于脊柱矫形术后可以提供更好的镇痛、镇静作用,减少持续静脉镇痛舒芬太尼总用量,降低术后恶心呕吐发生率。

Objective To investigate the effect of application of low-dose esketamine combined with sufentanil in continuous intravenous analgesia after spinal orthopedic surgery.Methods Thirty-six patients underwent elective spinal orthopedics from June 2020 to June 2021 were selected,18 males and 18 females,aged 18-64 years,BMI 17-29 kg/m^(2),ASA physical statusⅠ-Ⅲ,were divided into two groups using a completely randomized design method:esketamine combined with sufentanil group(group ES)and sufentanil alone group(group S),18 patients in each group.Group ES was given intravenous sufentanil 1.5μg/kg+esketamine 0.25 mg/kg for postoperative analgesia,and group S was given intravenous sufentanil 2μg/kg for postoperative analgesia.NRS scores at rest and during exercise and Ramsay sedation scores were recorded at 2,4,8,12,24,48 and 72 hours after surgery.The total number of PCIA compression,the number of effective compressions and total dosage of sufentanil using in PCIA were recorded.The time of hospital stay postoperatively was recorded.The incidence of adverse reactions such as dizziness,nausea and vomiting,and urine retention were recorded at 0-24,24-48,and 48-72 hours after surgery.Results Compared with group S,NRS scores were significantly decreased at 2,4,8,12,24,48,and 72 hours after surgery at rest and during exercise(P<0.05),Ramsay sedation scores were significantly increased at 2,4,8,and 12 hours after surgery(P<0.05),the total number of PCIA compression,the number of effective compressions and total dosage of sufentanil using in PCIA were significantly decreased(P<0.05),the incidence of nausea and vomiting 0-24 hours after surgery were significantly decreased(P<0.05).Conclusion Low-dose esketamine combined with sufentanil for continuous intravenous analgesia after spinal orthopedic surgery can provide better analgesic and sedative effects than sufentanil alone,reduce the total dosage of sufentanil,decrease the incidence of nausea and vomiting after operation.