小剂量艾司氯胺酮复合瑞芬太尼用于腹腔镜子宫肌瘤剔除术效果观察

Efficacy and safety of esketamine combined with remifentanil in patients undergoing laparoscopic uterine myomectomy

目的探讨小剂量艾司氯胺酮复合瑞芬太尼用于腹腔镜子宫肌瘤剔除术的效果及患者血流动力学指标、炎症因子及疼痛介质水平的变化。方法选取2020年6月至2021年12月温州市人民医院收治的行腹腔镜下子宫肌瘤剔除术患者90例,采用随机数字表法分为观察组和对照组,每组45例。对照组给予静脉推注丙泊酚2mg/kg、瑞芬太尼2μg/kg、维库溴铵0.1mg/kg行麻醉诱导,术中以丙泊酚5mg/(kg·h)和瑞芬太尼0.2μg/(kg·min)维持麻醉。观察组在对照组基础上,应用小剂量艾司氯胺酮0.3mg/(kg·h)术中持续泵注。分别于术后0.5、1、6、12、24h采用疼痛视觉模拟评分法(VAS)评估患者疼痛情况;测定并比较两组患者拔管时间、呼吸恢复时间及苏醒时间。采用酶联免疫吸附法测定患者入手术室时、手术结束时及术后24h血清中P物质(SP)、CRP、5-羟色胺(5-HT)、TNF-α、IL-6和前列腺素E_(2)(PGE_(2))水平;比较两组患者入手术室时、手术结束时及术后24h平均动脉压(MAP)和心率(HR),并记录不良反应发生情况。结果与对照组比较,观察组术后24hMAP、HR、IL-6、TNF-α、CRP、SP、PGE_(2)及5-HT水平均明显降低(均P<0.05),术后1、6、12、24h VAS评分均明显降低(均P<0.05)。两组患者拔管时间、呼吸恢复时间及苏醒时间比较差异均无统计学意义(均P>0.05)。观察组不良反应发生率为31.11%,对照组为35.56%,两组比较差异无统计学意义(P>0.05)。结论对于行子宫肌瘤剔除术患者,予以小剂量艾司氯胺酮复合瑞芬太尼能稳定术后血流动力学指标,抑制炎症因子释放及疼痛介质释放,且临床安全性较好。

Objective To investigate the efficiency and safety of low-dose esketamine plus remifentanil in patients undergoing laparoscopic uterine myomectomy.Methods Niety patients undergoing laparoscopic uterine myomectomy in Wenzhou People's Hospital from June 2020 to December 2021 were enrolled.Patients were randomly divided into two groups with 45 cases in each group.The control group received intravenous infusion of propofol 2 mg/kg,remifentanl 2μg/kg and vecuronium 0.1 mg/kg for induction,propofol 5 mg/(kg·h)and remifentanil 0.2μg/(kg·min)for maintaining anesthesia;while low-dose esketamine 0.3 mg/(kg·h)was added for intraoperative maintain in study group on the basis of the control group.The degree of pain was evaluated with visual analogue scale(VAS)at 0.5,1,6,12 and 24 h after surgery;the time of extubation,respiratory recovery and awakening was compared between the two groups.The serum levels of substance P(SP),C-reactive protein(CRP),serotonin(5-HT),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and prostaglandin E_(2)(PGE_(2))were measured by ELISA at the before surgery,completion of surgery and 24 h after surgery.The mean arterial pressure (MAP) and heart rate (HR) were at the same time;and the adverse reactions were recorded. Results Comparedwith the control group, the MAP and HR, the serum levels of IL-6, TNF- α, CRP, SP, PGE_(2), and 5-HT in study group weresignificantly reduced at 24 h after surgery (P < 0.05 or P < 0.01). the VAS score was significantly reduced at 1, 6, 12 and24 h in the study group (P<0.05 or P<0.01). There were no significant differences in the extubation time, respiratoryrecovery time or awakening time between two groups (P>0.05). Conclusion Low- dose esketamine combined withremifentanil in patients undergoing caparoscopic uterine myomectomy can stabilize postoperative hemodynamics, inhibit therelease of inflammatory factors, inhibit the secretion of pain mediators and reduce the pain of patients, resulting betterclinical safety.