艾司氯胺酮联合舒芬太尼PCIA对肾移植患者术后镇痛效果和早期肾功能的影响

Effects of esketamine combined with sufentanil PCIA on postoperative analgesia and early renal function in renal transplant patients

目的:探讨肾移植患者使用艾司氯胺酮联合舒芬太尼自控静脉镇痛(PCIA)的效果。方法:选取80例肾移植手术患者作为研究对象,根据不同麻醉方法将患者分为对照组与观察组,每组各40例。两组均予以相同麻醉诱导及麻醉维持,术后均予以PCIA。观察组镇痛配方为舒芬太尼+艾司氯胺酮+托烷司琼;对照组配方为舒芬太尼+托烷司琼。记录并比较两组术后4、8、24及48 h静息状态下疼痛评分,术后48 h内镇痛泵按压次数及补救镇痛率,麻醉前和术后24 h血清白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平,术前1 d及术后2 d血清肌酐(Cr)、尿素氮(BUN)水平。结果:与对照组比较,观察组术后4、8、24及48 h VAS评分均降低(P<0.05);术后48 h镇痛泵按压次数更少(P<0.05);补救镇痛率更低(P<0.05);术后24 h血清IL-6及TNF-α水平更低(P<0.05);术后2 d血清Cr、BUN水平下降(P<0.05)。结论:艾司氯胺酮联合舒芬太尼用于肾移植术后PCIA可提高术后镇痛效果,减轻患者术后炎症反应,有利于术后早期肾功能的恢复。

Objective:To investigate the effect of esketamine combined with sufentanil on patient-controlled intravenous analgesia(PCIA)after renal transplantation.Methods:A total of 80 patients undergoing renal transplantation were selected as the research objects,they were divided into control group and observation group according to the different anesthesia methods,with 40 cases in each group.The two groups were given the same anesthesia induction and anesthesia maintenance,and PCIA was given after operation.The analgesic formula of the observation group was sufentanil+esketamine+tropisetron,and the control group was sufentanil+tropisetron.Pain scores at 4,8,24 and 48 h after operation,pressing times of analgesia pump within 48 h after operation,remedial analgesia rate,levels of serum interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)before anesthesia and 24 h after operation,serum creatinine(Cr)and blood urea nitrogen(BUN)at 1 day before operation and 2 days after operation were recorded and compared between the two groups.Results:The VAS score of the observation group was lower at 4,8,24 and 48 h after operation comparing with the control group(P<0.05),and the number of analgesic pump compressions in the observation group was less at 48 h after operation(P<0.05),and the remedial analgesia rate was lower(P<0.05).At 24 h after operation,the serum IL-6 and TNF-αlevels in the observation group were lower than those in the control group(P<0.05).2 days after operation,the levels of serum Cr and BUN in the observation group were lower than those in the control group(P<0.05).Conclusion:Esketamine combined with sufentanil for PCIA after renal transplantation can improve the postoperative analgesic effect,reduce the postoperative inflammatory response,and is conducive to the recovery of early postoperative renal function.