艾司氯胺酮对瑞芬太尼痛觉过敏影响的临床观察

Clinical observation of the effect of esketamine on remifentanil-induced hyperalgesia

目的观察术前应用小剂量艾司氯胺酮对瑞芬太尼所致痛觉过敏的影响。方法选取大连市第三人民医院2021-06/2022-12期间择期行甲状腺切除术的患者100例,采用随机数字表法将患者分为艾司氯胺酮组(A组,n=50)和空白对照组(B组,n=50),ASA分级Ⅰ或Ⅱ级,年龄21~69岁,BMI 18~28 kg/m^(2),手术时间60 min。开放上肢静脉通路,缓慢静脉注射咪达唑仑0.03 mg/kg,舒芬太尼0.4μg/kg,依托咪酯0.2 mg/kg,罗库溴铵0.6 mg/kg,A组注射艾司氯胺酮0.3 mg/kg,B组注射等容积生理盐水。采用静吸复合麻醉,七氟醚1%,持续泵注丙泊酚2 mg/(kg·h),瑞芬太尼0.1μg/(kg·min),间断追加罗库溴铵,术毕停药。术前测量患者非优势手前臂和手术切口处皮肤的机械痛阈值,由麻醉护士记录术后2、4、8、12、24 h VAS评分。记录2组患者头晕(患者自述)、定向力(正确)、计算能力(正确)、复视、梦幻、谵妄等精神症状的发生情况。结果与B组比较,A组术后非优势手前臂和手术切口处皮肤的机械痛阈值具有统计学意义(P<0.05),2组患者术后(2、4、8、12、24 h)VAS评分比较均无统计学意义(P>0.05),2组患者围麻醉期精神症状(头晕、定向力、计算能力、复视、梦幻、谵妄)的比较均无统计学意义(P>0.05)。结论术前应用小剂量艾司氯胺酮(0.3 mg/kg)能够很好的抑制瑞芬太尼的痛觉过敏,改善患者苏醒期质量,提高了围术期患者满意度。

Objective To observe the effect of low-dose esketamine on hyperalgesia induced by remifentanil before operation.Methods A total of 100 ASAⅠorⅡpatients,aged 21-69 years,with body mass index 18-28 kg/m^(2),were randomly divided into esketamine group(group A,n=50)and blank control group(group B,n=50),the operation time of both groups were longer than 60 minutes.Then the upper limb venous access was obtained.Both groups were induced with midazolam 0.03 mg/kg,sufentanil 0.4μg/kg,etomidate 0.2 mg/kg,0.6 mg/kg.Group A were injected with escitalopram ketamine 0.3 mg/kg,and group B were injected with same volume of normal saline.Propofol 2 mg/(kg·h)and remifentanil 0.1μg/(kg·min)were continuously injected by pump.Rocuronium was added continuously.Non-dominant hand forearm and mechanical pain threshold of skin incision of patients were measured before the operation.VAS scores were recorded 2,4,8,12,24 h after the operation.The non-dominant hand forearm and mechanical pain threshold of skin incision were measured 24h after the operation and the rating scales were collected.The occurrence of mental symptoms of both groups such as dizziness(reported by the patients),orientation(correct),calculation ability(correct),diplopia,dreaminess,delirium and so on were recorded.Results There was significant difference between group A and group B in the mechanical pain threshold of non-dominant hand forearm and skin of surgical incision(P<0.05).There was no significant difference in VAS score between group A and group B(2,4,8,12,24 h)after operation(P>0.05).There was no significant difference in perianesthesia psychiatric symptoms(dizziness,orientation,calculation ability,diplopia,dreamlike and delirium)between groups A and group B(P>0.05).Conclusion Preoperative application of low-dose esketamine(0.3 mg/kg)can effectively inhibit remifentanil hyperalgesia,improve the quality of recovery period,and improve perioperative patient satisfaction.