艾司氯胺酮用于妇科腹腔镜下子宫肌瘤剔除术后镇痛的效果观察

Observation of the Analgesic Effect of Esketamine after Hysteromyomectomy under Gynecological Laparoscopy

目的:探讨小剂量艾司氯胺酮(Esketamine)复合舒芬太尼(Sufentanil)用于妇科腹腔镜(Gynecological laparoscopy)术后静脉镇痛的效果。方法:选取择期妇科腹腔镜下子宫肌瘤剔除术80例,随机分为S组和KS组,每组40例。两组患者均实施全麻并于术后PCIA镇痛,S组:舒芬太尼50μg+昂丹司琼8mg,KS组:舒芬太尼25μg+艾司氯胺酮25mg+昂丹司琼8mg,均加入0.9%氯化钠配至50mL。为评价两组术后镇痛效果,主要监测指标:术后2h(T_(1))、6h(T_(2))、24h(T_(3))时刻VAS,次要指标为MAP、HR和PCIA按压次数、24h内不良反应、术前与术后焦虑抑郁程度(HADS量表)以及术后镇痛满意度。结果:S组的T_(2)、T_(3)时VAS高于KS组(P<0.05),T_(1)时两组比较差异无统计学意义(P>0.05);S组的PCIA单次按压次数高于KS组,(P<0.01);在T_(1)、T_(2)、T_(3),两组间MAP和HR比较均无统计学意义(P>0.05);S组患者术后24hHADS-A评分明显高于KS组(P<0.05);S组不良反应嗜睡、皮肤瘙痒例数高于KS组,(P<0.05),恶心呕吐、头晕例数比较无统计学意义(P>0.05);S组患者术后镇痛缓解疼痛百分比和术后镇痛满意度均低于KS组。结论:小剂量艾司氯胺酮复合舒芬太尼用于妇科腔镜术后静脉镇痛,镇痛效果良好,减少不良反应且提高患者术后镇痛满意度。

Objective:To investigate the effect of low-dose Esketamine combined with sufentanil on postoperative intravenous analgesia after gynecological laparoscopic surgery.Methods:A total of 80 cases of elective gynecological laparoscopic myomectomy were randomly divided into S group and KS group,with 40 cases in each group.Both groups of patients were given general anesthesia and PCIA analgesia after operation.Group S:sufentanil 50μg+ondansetron 8 mg,group KS:sufentanil 25μg+esketamine 25 mg+ondansetron 8 mg,and 0.9%sodium chloride was added to 50ml.To evaluate the postoperative analgesia effect of the two groups,the main monitoring indicators were VAS at 2h(T_(1)),6h(T_(2))and 24h(T_(3))after operation,and the secondary indicators were MAP,HR and PCIA press times,adverse reactions within 24h,preoperative and postoperative anxiety and depression(HADS scale),and postoperative analgesia satisfaction.Results:VAS of S group at T_(2) and T_(3) was higher than that of KS group(P<0.05),and there was no significant difference between the two groups at T_(1)(P>0.05).The number of PCIA single press in group S was higher than that in group KS(P<0.01).In T_(1),T_(2) and T_(3),there was no significant difference in MAP and HR between the two groups(P>0.05).The score of HADS-A in group S was significantly higher than that in group KS(P<0.05).The number of cases of adverse reactions such as drowsiness and skin itching in group S was higher than that in group KS(P<0.05),while the number of cases of nausea,vomiting and dizziness was not statistically significant(P>0.05).The percentage of pain relief and satisfaction of postoperative analgesia in group S were lower than those in group KS.Conclusion:Low-dose Esketamine combined with sufentanil for intravenous analgesia after gynecological endoscopic surgery has a good analgesic effect,reduces adverse reactions,and improves patients'satisfaction with postoperative analgesia.