亚麻醉剂量艾司氯胺酮对甲状腺癌根治术后患者苏醒及疼痛的影响

Effect of subanesthetic dose of esketamine on recovery and pain in patients with thyroid cancer after radical surgery

目的研究亚麻醉剂量艾司氯胺酮对甲状腺癌根治术(Radical resection of thyroid carcinoma,RRTC)后患者苏醒及疼痛的影响。方法选取2020年8月-2021年3月安庆市立医院麻醉科行RRTC的90例患者为研究对象,采用随机数字表法将患者分为A、B、C组,每组30例,A组术中持续输注生理盐水;B组术中持续输注艾司氯胺酮0.25 mg·kg^(-1)·h^(-1);C组术中持续输注艾司氯胺酮0.5 mg·kg^(-1)·h^(-1)。观察各组患者术中各时间点[麻醉诱导前(T_(0))、注射药物5 min后(T_(1))、气管插管后(T_(2))、手术结束(T_(3))、术后1 h(T_(4))]心率(Heart rate,HR)、平均动脉压(Mean arterial pressure,MAP)、动脉压水平波动情况,统计术中丙泊酚、瑞芬太尼用量;观察各组患者术后不同时间的镇静情况(Ramsay镇静评分)及疼痛情况(VAS评分)。统计手术相关指标,并记录患者麻醉不良反应发生情况。结果与本组T_(0)时刻比较,A组T_(1)时刻HR降低,A、B、C组T_(2)时刻HR升高,差异有统计学意义(P<0.05);与A组T_(1)时刻比较,C组T_(1)时刻HR升高,差异有统计学意义(P<0.05);与A组T_(2)时比较,B、C组T_(2)时刻HR降低,差异有统计学意义(P<0.05)。与本组T_(0)时刻比较,B、C组T_(1)时刻MAP升高,A、B、C组T_(2)时刻MAP升高,差异有统计学意义(P<0.05);与A组T_(1)时刻比较,B、C组T_(1)时刻MAP升高,差异有统计学意义(P<0.05);与A组T_(2)时比较,C组T_(2)时刻MAP升高,差异有统计学意义(P<0.05);与A组T_(4)、T_(5)时刻比较,B、C组T_(4)、T_(5)术后Ramsay镇静评分均升高,差异有统计学意义(P<0.05);与本组T_(4)时刻比较,3组T_(6)、T_(7)、T_(8)时刻术后Ramsay镇静评分均降低,差异有统计学意义(P<0.05);与B组T_(4)、T_(5)、T_(6)、T_(7)、T_(8)时刻比较,C组术后T_(4)、T_(5)、T_(6)、T_(7)、T_(8)时刻Ramsay镇静评分比较,差异无统计学意义(P>0.05);与B组T_(7)、T_(8)时刻比较,C组T_(7)、T_(8)时刻VAS评分降低,差异有统计学意义(P<0.05);与本组T_(4)时刻比较,3组T_(6)、T_(7)、T_(8)时刻VAS评分均降低(P<0.05);3组拔管时间、苏醒时间比较,差异无统计学意义(P>0.05);与A组术后第1天引流量比较,B、C组术后第1天引流量均降低,拔管呛咳的发生率降低,差异有统计学意义(P<0.05)。结论0.25 mg·kg^(-1)·h^(-1)亚麻醉剂量的艾司氯胺酮能够维持RRTC患者术中血流动力学稳定,改善患者术后镇静及疼痛情况,未延长苏醒及拔管时间,同时能够减少术后引流量及拔管呛咳的发生,具有良好的安全性。

Objective To investigate the effects of subanesthetic esketamine on recovery and pain after radical resection of thyroid carcinoma(RRTC).Methods A total of 90 patients who underwent RRTC in the hospital from August 2020 to March 2021 were selected as the study objects.The patients were divided into groups A,B and C with 30 cases in each group by random number table method.Group A received continuous infusion of normal saline during the operation.Group B was given 0.25 mg·kg^(-1)·h^(-1) esketamine continuously during the operation.Group C was continuously injected with esketamine 0.5 mg·kg^(-1)·h^(-1) during the operation.The fluctuation of point heart rate and arterial pressure of the patients in each group at various times during the operation[before anesthesia induction(T_(0)),5min after drug injection(T_(1)),after tracheal intubation(T_(2)),after surgery(T_(3)),1 h after surgery(T_(4))]were observed.The intraoperative dosage of propofol and remifentanil were counted,and the postoperative sedation(Ramsay sedation score)and pain(VAS score)of each group were observed.The relevant indexes of the operation were counted,and the occurrence of anesthesia adverse reactions was recorded.Results Compared with the T_(0) moment of the group,the HR index at T_(1) moment of group A was decreased,and the HR index at T_(2) moment of group A,B and C was increased,with statistical significance(P<0.05).Compared with group A at T_(1) time,HR in group C was higher at T_(1) time,and the difference was statistically significant(P<0.05).Compared with group A at T_(2),HR in groups B and C was lower at T_(2),and the difference was statistically significant(P<0.05).Compared with the T_(0) moment of this group,the MAP of groups B and C wasincreased at T_(1) moment,and that of groups A,B and C was increased at T_(2) moment,with statistical significance(P<0.05).Compared with group A at T_(1) time,MAP of groups B and C wasincreased at T_(1) time,and the difference was statistically significant(P<0.05).Compared with group A at T_(2),MAP of group C wasincreased at T_(2),and the difference was statistically significant(P<0.05).Compared with T_(4) and T_(5) moments of group A,Ramsay sedation scores of group B and C after T_(4) and T_(5) were increased,and the difference was statistically significant(P<0.05).Compared with T_(4) moment,Ramsay sedation score at T_(6),T_(7) and T_(8) moments of the 3 groups was lower,and the difference was statistically significant(P<0.05).Compared with group B at T_(4),T_(5),T_(6),T_(7) and T_(8),there was no significant difference in Ramsay sedation score at T_(4),T_(5),T_(6),T_(7) and T_(8) in group C(P>0.05).Compared with group B at T_(7) and T_(8),VAS scores in group C at T_(7) and T_(8) were lower,and the difference was statistically significant(P<0.05).Compared with T_(4),VAS scores at T_(6),T_(7) and T_(8) of the 3 groups were decreased(P<0.05).There was no significant difference in extubation time and recovery time among the 3 groups(P>0.05).Compared with group A on the 1st day after the surgery,the drainage flow in groups B and C was decreased,and the incidence of tubation choking was decreased,with statistical significance(P<0.05).Conclusion 0.25 mg·kg^(-1)·h^(-1) subanesthetic dose of Esketamine can maintain the intraoperative hemodynamic stability of RRTC patients,improve postoperative sedation and pain,did not prolong recovery and extubation time,and it can reduce postoperative drainage flow and extubation choking,with good safety.