艾司氯胺酮用于腹腔镜胃肠肿瘤切除术后自控静脉镇痛的效果

The effect of esketamine combined with propofol in patient-controlled intravenous analgesia after laparoscopic gastrointestinal tumor resection

目的:评价艾司氯胺酮复合丙泊酚用于腹腔镜胃肠肿瘤切除术后自控静脉镇痛的效果。方法:选择2020年7月至2021年8月在全身麻醉下行腹腔镜胃肠肿瘤切除术的92例患者,40~70岁,BMI 18~25 kg/m^(2),ASA分级Ⅱ~Ⅲ级,应用随机数字表法分为E组(艾司氯胺酮)与P组(丙泊酚),每组46例。两组均以舒芬太尼、顺式阿曲库铵行麻醉诱导,靶控输注丙泊酚麻醉维持,间断输入顺式阿曲库铵以维持肌松。术毕接通镇痛泵行自控静脉镇痛。E组配方:艾司氯胺酮2 mg/kg、酮咯酸氨丁三醇90 mg、托烷司琼5 mg,用生理盐水稀释至100 mL;P组配方:丙泊酚2.5 mg/kg、酮咯酸氨丁三醇90 mg、托烷司琼5 mg,用生理盐水稀释至100 mL。记录手术完毕(T_(1))、术后6 h(T_(2))、术后24 h(T_(3))、术后48 h(T_(4))时患者Ramsay镇静评分与疼痛数字评分。应用40项恢复质量量表评估术后恢复情况。结果:T_(1)、T_(2)、T_(3)时,E组镇静评分均高于P组,疼痛评分均低于P组(P<0.05)。E组术后呼吸抑制(0 vs.8.7%)、恶心呕吐(8.7%vs.23.91%)、皮肤瘙痒(2.17%vs.15.22%)发生率低于P组(P<0.05)。T_(3)、T_(4)时,E组舒适度、情绪状态、心理支持、自理能力及恢复质量总分均高于P组(P<0.01)。结论:艾司氯胺酮复合丙泊酚可提高腹腔镜胃肠肿瘤切除术患者术后镇痛效果,促进术后早日康复,减少不良反应的发生。

Objective:To evaluate the effect of esketamine compounded with propofol on patient-controlled intravenous analgesia after laparoscopic gastrointestinal tumor resection.Methods:Ninety-two patients,aged 40-70 years old,with BMI of 18-25 kg/m^(2)and ASA gradeⅡ-Ⅲ,underwent laparoscopic gastrointestinal tumor resection under general anesthesia from Jul.2020 to Aug.2021,were s elected and randomly divided into groups esketamine(E)and group propofol(P)by the random number table method,with 46 cases in each group.Both groups were given sufentanil and cisatracurium for induction of anesthesia,target-controlled infusion of propofol for maintenance of anesthesia,and intermittent infusion of cisatracurium for maintenance of muscle relaxation.Patient-controlled intravenous analgesia was performed at the end of surgery.The formula of group E included esketamine 2 mg/kg,ketorolac tromethamine 90 mg and tropisetron 5 mg,diluted to 100 mL with normal saline;the formula of group P included propofol 2.5 mg/kg,ketorolac tromethamine 90 mg and tropisetron 5 mg,diluted to 100 mL with normal saline.The changes of Ramsay sedation score and pain numeric rating score at the end of operation(T_(1)),postoperative 6 h(T_(2)),postoperative 24 h(T_(3))and postoperative 48 h(T_(4))were recorded.A 40-item quality of recovery scale was applied to assess postoperative recovery.Results:At T_(1),T_(2)and T_(3),sedation scores were higher and pain scores were lower in group E than those in group P(P<0.05);the incidence of postoperative respiratory depression(0 vs.8.7%),nausea and vomiting(8.7%vs.23.91%),and skin pruritus(2.17%vs.15.22%)was lower in group E than that in group P(P<0.05).At T_(3)and T_(4),the scores of comfort,emotional state,psychological support,self-care ability and the quality of recovery total scores were higher in group E than those in group P(P<0.01).Conclusions:Esketamine compounded with propofol can improve the postoperative analgesic effect in patients undergoing laparoscopic gastrointestinal tumor resection,promote early postoperative recovery,and reduce the occurrence of adverse reactions.