艾司氯胺酮对肥胖患者全身麻醉手术瑞芬太尼用量和术后疼痛的影响

Effects of esketamine on remifentanil dosage and postoperative pain in obese patients undergoing general anesthesia

目的评价艾司氯胺酮对肥胖患者全身麻醉手术阿片类药物用量和术后疼痛的影响。方法本研究为临床对照设计实验,选择2020年6月至2021年5月行择期非胸科手术的全身麻醉肥胖患者60例,年龄18~65岁,体质量指数(BMI)大于28 kg/m^(2),麻醉分级Ⅱ~Ⅲ级。采用随机数字表法分为试验组和对照组,各30例。试验组使用艾司氯胺酮、丙泊酚、舒芬太尼及顺阿曲库铵进行麻醉诱导,对照组采用丙泊酚及相同剂量的舒芬太尼、顺阿曲库铵进行麻醉诱导。麻醉维持试验组以艾司氯胺酮、七氟烷、瑞芬太尼维持,对照组以丙泊酚、七氟烷、瑞芬太尼维持,维持剂量的七氟烷、丙泊酚、艾司氯胺酮用法恒定,瑞芬太尼两组患者根据术中调整剂量,其余药物、补液一致。术后均以氟比洛芬酯静脉泵镇痛。分别记录两组患者术后视觉模拟量表评分及瑞芬太尼的用量。组间比较采用独立样本t检验、χ^(2)检验。结果试验组术后2 h、6 h、12 h、24 h的视觉模拟量表评分分别为(2.37±0.50)、(3.05±0.46)、(3.30±0.47)、(3.40±0.64)分,对照组分别为(2.85±1.13)、(3.45±0.42)、(3.70±1.19)、(3.90±0.90)分,两组比较,差异均有统计学意义(均P<0.05);试验组瑞芬太尼的用量为(1130.00±109.92)μg,对照组为(1210.00±108.12)μg,两组比较,差异有统计学意义(t=2.842,P=0.006)。结论艾司氯胺酮能减少肥胖患者全身麻醉手术的瑞芬太尼用量,能降低手术疼痛评分。

Objective To evaluate the effects of esketamine on remifentanil dosage and postoperative pain in obese patients undergoing general anesthesia.Methods Sixty obese patients taking selective non-chest surgery at Jiangmen Central Hospital from June 2020 to May 2021 were selected for the clinical control trial;they were 18-65 years old;their body mass index(BMI)was over 28 kg/m^(2);the anesthesia grade wasⅡ-Ⅲ.The patients were divided into an experimental group and a control group,with 30 cases in each group.The experimental group used esticketamine,propofol,sufentanil,and cisatracurium for anesthesia induction.The control group used sufentanil and cisatracurium at the same doses and a different dose of propofol for anesthesia induction.The experimental group took esticketamine,sevoflurane,and remifentanil for anesthesia maintenance.The control group took propofol,sevoflurane,and remifentanil for anesthesia maintenance.In both groups,the doses of sevoflurane,propofol,and esticketamine were constant,and the doses of remifentanil were adjusted according to intraoperative hemodynamic changes.Other drugs and fluids were consistent.Postoperative analgesia were induced by intravenous pump with flurbiprofen axetil in both groups.The amounts of remifentanil and postoperative Visual Analogue Scale(VAS)pain scores of both groups were recorded.The data were compared between these two groups by independent-sample t test andχ^(2)test.Results The VAS scores 2,6,12,and 24 h after operation in the experimental group were lower than those in the control group[(2.37±0.50)vs.(2.85±1.13),(3.05±0.46)vs.(3.45±0.42),(3.30±0.47)vs.(3.70±1.19),and(3.40±0.64)vs.(3.90±0.90)],with statistical differences(P<0.05).The amount of remifentanil in the experimental group was less than that in the control group[(1130.00±109.92)μg vs.(1210.00±108.12)μg],with a statistical difference(t=2.842,P=0.006).Conclusion Esketamine can reduce remifentanil dosage and postoperative pain score in obese patients undergoing general anesthesia.