艾司氯胺酮用于腹腔镜全子宫切除患者术后镇痛效果的临床观察

Clinical Observation on Analgesic Effect of Esketamine in Patients with Laparoscopic Total Hysterectomy

目的:观察艾司氯胺酮用于腹腔镜全子宫切除患者静脉自控镇痛(PCIA)的临床效果。方法:选择国药东风总医院2021年5月—2022年6月择期行腹腔镜全子宫切除术患者90例,随机分为舒芬太尼组(S组)、低剂量艾司氯胺酮组(E1组)、高剂量艾司氯胺酮组(E_(2)组),每组30例。S组术后镇痛方案为舒芬太尼100µg+托烷司琼4 mg;E1组为舒芬太尼100µg+艾司氯胺酮80 mg+托烷司琼4 mg;E_(2)组为舒芬太尼100µg+艾司氯胺酮150 mg+托烷司琼4 mg。记录三组术后4、8、12、24、48 h的视觉模拟评分法(VAS)评分、Ramsay镇静评分、患者自控镇痛(PCA)按压总次数及舒芬太尼总用量;记录术后不良反应的发生情况,以及术后第3、6个月出现慢性疼痛情况。结果:术后4、8、12、24、48 h,三组VAS评分和Ramsay镇静评分比较差异均无统计学意义(P>0.05);与S组相比,E1组与E_(2)组术后舒芬太尼总用量、48 h内PCA按压总次数均明显少,差异均有统计学意义(P<0.05),但E1组与E_(2)组比较差异均无统计学意义(P>0.05)。与S组比较,E1组与E_(2)组术后第3、6个月出现慢性疼痛患者比例均明显低,差异均有统计学意义(P<0.05),E1组与E_(2)组比较差异均无统计学意义(P>0.05)。E1组术后恶心呕吐不良反应的发生率均低于E_(2)组与S组,差异均有统计学意义(P<0.05),E_(2)组不良反应发生率与S组比较差异均无统计学意义(P>0.05)。结论:舒芬太尼复合低剂量艾司氯胺酮用于PCIA对于急性疼痛能产生较为良好的镇痛效果,减少术后阿片类药物总用量及不良反应的发生率,并减少术后慢性疼痛的发生。

Objective:To observe the clinical effect of Esketamine on patient-controlled intravenous analgesia(PCIA)after laparoscopic hysterectomy.Method:A total of 90 patients who underwent elective laparoscopic total hysterectomy from May 2021 to June 2022 in Dongfeng General Hospital of Sinopharm were selected and randomly divided into Sufentanil group(group S),low-dose Esketamine group(group E1)and high-dose Esketamine group(group E_(2)),with 30 cases in each group.The postoperative analgesia regimen of the group S,Sufentanil 100µg+Tropisetron 4 mg;group E1,Sufentanil 100µg+Esketamine 80 mg+Tropisetron 4 mg;group E_(2),Sufentanil 100µg+Esketamine 150 mg+Tropisetron 4 mg.Visual analog scale(VAS)scores,Ramsay sedation scores at 4,8,12,24,and 48 h after surgery,total number of patient-controlled analgesia(PCA)compressions and total dosage of Sufentanil were recorded in three groups.The occurrence of postoperative adverse reactions and patients with chronic pain 3 and 6 months after surgery were recorded.Result:There were no significant differences in VAS scores and Ramsay sedation scores at 4,8,12,24 and 48 h after surgery in three groups(P>0.05).Compared with group S,the total dosage of Sufentanil and the total number of PCA within 48 h in group E1 and group E_(2) were significantly less,the differences were statistically significant(P<0.05),but there were no statistical significance between group E1 and group E_(2)(P>0.05).Compared with the group S,the rates of patients with chronic pain in the 3rd and 6th month after surgery in the group E1 and group E_(2) were significantly lower,the differences were statistically significant(P<0.05),while there were no statistically significant differences between the group E1 and group E_(2)(P>0.05).The incidence of postoperative adverse reactions to nausea and vomiting in group E1 was lower than those in group E_(2) and group S,the differences were statistically significant(P<0.05),but there were no statistically significant differences between group E_(2) and group S(P>0.05).Conclusion:Sufentanil combined with low-dose Esketamine for PCIA can produce a better analgesic effect on acute pain,reduce the total amount of postoperative opioids and the incidence of adverse reactions,and reduce the occurrence of postoperative chronic pain.