小剂量氯胺酮联合布托啡诺对子宫肌瘤剔除术后镇痛效果及术后恢复影响

Effect of low-dose ketamine combined with butorphanol for postoperative analgesia of patients with myomectomy and its influence on the postoperative recovery of the patients

目的:探讨小剂量氯胺酮联合布托啡诺对子宫肌瘤剔除术后镇痛效果及术后恢复影响。方法:采用便利抽样方法选取2019年1月-2021年11月本院行子宫肌瘤剔除术患者110例,依据随机数字表法分为氯胺酮+布托啡诺组(联合组)、布托啡诺组(单一组)各55例,两组术后均予以布托啡诺自控静脉镇痛(PCIA),联合组同时予以小剂量氯胺酮。比较两组术后6 h、12 h、24 h视觉模拟评分法(VAS)评分、Ramsay镇静评分;术前、术后6 h、24 h血清应激指标[皮质醇(Cor)、去甲肾上腺素(NE)];术后24 h、48 h匹兹堡睡眠质量指数(PSQI)量表、40项恢复质量评分量表(QoR-40);术后首次排便、首次自主活动及住院时间;不良反应发生情况。结果:联合组术后6 h、12 h、24 h VAS评分均低于单一组,Ramsay评分高于单一组;两组术后6 h、24 h血清Cor、NE水平均高于术前,但联合组低于单一组;术后24 h、48 h的PSQ评分联合组低于单一组,QoR-40评分高于单一组;联合组术后首次排便(3.04±0.79d)、首次自主活动(3.57±1.06d)及住院时间(4.52±1.24d)均少于单一组(4.18±1.25d、4.96±1.37d、6.08±1.53d)(均P<0.05)。不良反应总发生率联合组(10.9%)与单一组(18.2%)无差异(P>0.05)。结论 应用小剂量氯胺酮联合布托啡诺PCIA可显著提高子宫肌瘤剔除术后镇痛、镇静效果,减轻患者应激反应,促进恢复及睡眠改善,且安全性可靠。

Objective:To investigate the effect of low-dose ketamine com bined with butorphanol for postoperative anal-gesia of patients with myomectomy,and to study its influence on the postoperative recovery of the patients.Methods:A convenient sampling method was used to select 110 patients who wanted myomectomy from January 2019 to Novem-ber 2021.According to the random number table,these patients were divided into two groups(55 cases in each group).Postoperative patient controlled intravenous analgesia(PCIA)with butorphanol was given to the patients in the two groups for postoperative analgesia.The small dose ketamine was also given to the patients in the study group addition-ally.The visual analogue score(VAS)score and Ramsay sedation score in postoperative 6h,12h,and 24h,the levels of serum stress indexes,such as cortisol(Cor)and noradrenaline(NE),before operation and in postoperative 6h and 24h,the scores of Pittsburgh Sleep Quality Index(PSQI)scale and 40-item Recovery Quality Score Scale(QoR-40)in post-operative 24h and 48h,the time of first defecation,the time of first independent activity,and the duration of hospital stay,and the adverse reactions rate of the patients were compared between the two groups.Results:The VAS score of the patients in the study group in postoperative 6h,12h,and 24h was significantly lower than that of the patients in the control group,while the Ramsay score of the patients in the study group was significantly higher.The serum Cor and NE levels of the patients in the study group in postoperative 6h and 24h were significantly higher than those before operation,but which of the patients in the study group were significantly lower than those of the patients in the control group.The PSQ score of the patients in study group in postoperative 24h and 48h was significantly lower than that of the patients in the control group,and the QoR-40 score of the patients in the study group in postoperative 24h and 48h was significantly higher.The time of the first postoperative defecation(3.04±0.79d),the first voluntary activity(3.57±1.06d),and the duration of hospital stay(4.52±1.24d)of the patients in the study group were significantly less than those(4.18±1.25d,4.96±1.37d,and 6.08±1.53d)of the patients in the control group(all P<0.05).There was no significant difference in the total incidence of adverse reactions(10.9%vs.18.2%)of the patients between the two groups(P>0.05).Conclusion:The low-dose ketamine combined with butorphanol for postoperative analgesia of the patients with myomectomy can significantly improve their postoperative analgesic and sedative effects,can reduce their stress reaction,and can promote their recovery and sleep,with reliable safety.