小剂量艾司氯胺酮联合布托菲诺对妇科腹腔镜术后患者痛觉过敏的影响

Effect of low-dose esketamine combined with butorphanol on postoperative hyperalgesia patients

目的:探讨小剂量艾司氯胺酮联合布托菲诺对妇科腹腔镜术后患者痛觉过敏的影响。方法:选取2022年11月—2023年3月南通大学附属医院择期拟行腹腔镜下妇科手术患者96例,ASAⅠ~Ⅱ级,随机分为4组,每组24例。4组均予常规麻醉诱导,S组:0.4 mg/kg艾司氯胺酮;B组:20μg/kg布托菲诺;S+B组:0.25 mg/kg艾司氯胺酮+15μg/kg布托菲诺;A组:生理盐水,4组均于缝皮前20 min静脉推注。比较4组患者不同时间点视觉模拟评分(visual analogue score,VAS)、血流动力学指标、痛觉过敏率及术后不良反应发生情况。结果:4组患者术后2、6 h的VAS评分差异有统计学意义,S+B组VAS评分均低于其他3组,S组和B组均低于A组(均P<0.05);麻醉前及诱导后4组患者平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)比较差异无统计学意义(P>0.05),拔管时刻4组患者MAP、HR与麻醉前比较差异有统计学意义,S+B组患者MAP、HR均低于其他3组(均P<0.05);S+B组与A组痛觉过敏发生率比较差异有统计学意义(P<0.05),其余组比较差异无统计学意义;4组患者瑞芬太尼用量、手术时间、拔管时间比较差异均无统计学意义(均P>0.05);S组苏醒时间长于其他3组(P<0.05)。结论:小剂量艾司氯胺酮联合布托菲诺用于妇科腹腔镜手术患者能增强其镇痛、镇静效果,减少痛觉过敏现象,进而降低应激反应,减少术后躁动现象。

Objective:To investigate the effect of low-dose esketamine compounded with butorphanol on nociceptive hypersensitivity in patients after gynecological laparoscopy.Methods:Ninety-six patients admitted to the Affiliated Hospital of Nantong University from November 2022 to March 2023 for elective proposed laparoscopic gynecological surgery,ASAⅠ-Ⅱ,were selected and divided into 4 groups randomizedly,with 24 cases in each group.All 4 groups were induced by routine anesthesia,group S:0.4 mg/kg esketamine;group B:20μg/kg butorphanol;group S+B:0.25 mg/kg esketamine and 15μg/kg butorphanol;group A:saline.All 4 groups were administered intravenously 20 min before suture skin.The visual analogue score(VAS),hemodynamic indexes,nociceptive hypersensitivity rate and the occurrence of postoperative adverse reactions were compared among the 4 groups at different time points.Results:The VAS scores of the 4 groups were significantly different at 2 h and 6 h after surgery,and the VAS scores of the group S+B were lower than those of the other three groups,the group S and group B were lower than those of the group A(all P<0.05);there were no significant differences in mean arterial pressure(MAP)and heart rate(HR)indexes between before and after induction in the 4 groups(P>0.05),and the MAP and HR on the 4 groups at extubation time was compared with that before anesthesia,and the difference was statistically significant.of the 4 groups at the moment of extubation compared with those before anesthesia.MAP and HR were significantly lower in the group S+B than in the other three groups(all P<0.05).There was statistical significance in the incidence of hyperalgesia between group S+B and group A after operation(P<0.05),while there was no statistical significance among the other groups.There was no significant difference in the amount of remifentanil,operation time,and extubation time among the 4 groups(P>0.05);group S had a longer awakening time than the other three groups(P<0.05).Conclusion:The application of low-dose esketamine compounded with butorphanol to patients undergoing gynecological laparoscopic surgery can increase their analgesic and sedative effects,reduce the phenomenon of nociceptive hypersensitivity,and thus reduce the stress reaction and postoperative agitation.