艾司氯胺酮复合酮咯酸氨丁三醇抑制雷米芬太尼诱发痛觉过敏的效果

Effect of esketamine combined with ketorolac tromethamine in preventing remifentanil-induced hyperalgesia

目的 探讨艾司氯胺酮复合酮咯酸氨丁三醇抑制雷米芬太尼诱发痛觉过敏的效果。方法 择期全身麻醉下行腹腔镜全子宫切除术患者60例随机分为两组,每组30例。EK组于麻醉诱导前20 min静脉注射酮咯酸氨丁三醇15 mg,切皮前10 min静脉注射艾司氯胺酮0.125 mg/kg。C组在相同时间点静脉注射等量生理盐水作为对照。术前及术后12、24及48 h测定切口周围及优势臂内侧的机械痛阈值;记录术后3、6、12、24和48 h静息及咳嗽疼痛数字评定量表(NRS)评分;记录术后0~6 h、7~12 h、13~18 h、19~24 h和0~24 h舒芬太尼消耗量以及首次镇痛时间;术后48 h内观察不良反应发生情况。结果 C组术后12、24及48 h切口周围及优势臂内侧的机械痛阈值低于术前(P<0.05),EK组术后48 h切口周围及优势臂内侧的机械痛阈值低于术前(P<0.05)。与C组比较,EK组术后12、24 h切口周围及优势臂内侧的机械痛阈值增加(P<0.05),术后3、6和12 h静息NRS评分降低(P<0.05),术后3、6、12和24 h咳嗽NRS评分降低(P<0.05),术后0~6 h、7~12 h、13~18 h、19~24 h和0~24 h舒芬太尼消耗量减少(P<0.05),首次镇痛时间延长(P<0.05)。两组不良反应发生比例差异无统计学意义(P>0.05)。结论 艾司氯胺酮复合酮咯酸氨丁三醇可有效抑制雷米芬太尼在腹腔镜全子宫切除术后诱发的痛觉过敏,且不增加不良反应。

Objective To investigate the effect of esketamine combined with ketorolac tromethamine in preventing remifentanil-induced hyperalgesia.Methods Sixty patients undergoing elective laparoscopic total hysterectomy under general anesthesia were randomly assigned into two groups with 30cases each.The patients of group EK received intravenous ketorolac tromethamine 15mg on 20minutes before induction of anesthesia and esketamine 0.125mg/kg on 10minutes before skin incision.The patients of group C were intravenously injected with the same volume of normal saline at the time points.The mechanical pain thresholds around the incision and medial dominant arm were measured before operation and at 12,24and 48hours after operation.The resting and cough pain numerical rating scale(NRS)scores at 3,6,12,24and 48hours after operation were recorded.The sufentanil consumption during 0-6,7-12,13-18,19-24and 0-24hours after operation and the first time of analgesic use were recorded.The adverse reactions within 48hours after operation were observed.Results The mechanical pain thresholds around the incision and medial dominant arm were lower in group C at 12,24and 48hours after operation,and those were lower in group EK at 48hours after operation than those before operation(P<0.05).Compared with group C,the mechanical pain thresholds around the incision and medial dominant arm were increased at 12and 24hours after operation,resting NRS scores were decreased at 3,6and 12hours after operation,cough NRS scores were decreased at 3,6,12and 24hours after operation,sufentanil consumptions were decreased during 0-6,7-12,13-18,19-24and 0-24hours after operation,and the first time of analgesic use was prolonged in group EK(P<0.05).The incidence of adverse reactions after surgery was not significantly different between the two groups(P>0.05).Conclusion Esketamine combined with ketorolac tromethamine can effectively prevent remifentanil-induced hyperalgesia after laparoscopic total hysterectomy without increasing adverse reactions.