艾司氯胺酮联合舒芬太尼对髋关节置换术后镇痛及抑郁情绪的影响

Effects of esketamine combined with sufentanil on postoperative analgesia and depression after hip arthroplasty

目的 评估艾司氯胺酮联合舒芬太尼对行髋关节置换术患者术后镇痛效果及抑郁情绪的影响。方法 选择择期行髋关节置换术的患者60例,根据患者自控静脉镇痛方案分为S组、SK1组和SK2组,每组20例。S组患者术后镇痛采用舒芬太尼2μg/kg,SK1组患者术后镇痛采用艾司氯胺酮1 mg/kg+舒芬太尼2μg/kg,SK2组患者术后镇痛采用艾司氯胺酮2 mg/kg+舒芬太尼2μg/kg。在术后1、4、24、48 h,采用数字评分法(NRS)评估患者镇痛效果,采用Ramsay镇静评分评估患者镇静效果。术前及术后48 h采用抑郁自评量表(SDS)评估患者的抑郁情绪。记录患者术后48 h内恶心呕吐、头晕头痛、呼吸抑制、精神症状等相关不良反应。结果 术后1、4、24 h,SK1组和SK2组患者的NRS评分均低于S组(P<0.05);术后48 h,各组患者的NRS评分比较差异无统计学意义(P>0.05);术后不同时间点,SK1组和SK2组患者NRS评分比较差异均无统计学意义(P>0.05)。术后48 h,各组患者的SDS评分均低于术前(P<0.05)。各组患者术后不同时间点的Ramsay评分组间比较差异无统计学意义(P>0.05)。术后48 h内,SK2组患者的不良反应总发生率高于S组和SK1组(P<0.05)。结论 髋关节置换术后使用1 mg/kg艾司氯胺酮联合2μg/kg舒芬太尼的镇痛效果较好,且未明显增加不良反应,但在改善患者抑郁情绪方面效果不显著。

Objective To evaluate the effects of ketamine combined with sufentanil on postoperative analgesia and depression in patients undergoing hip arthroplasty.Methods A total of 60 patients who underwent elective hip arthroplasty were selected and divided into the S group,the SK1 group and the SK2 group according to the patient-controlled intravenous analgesia regimen,with 20 cases in each group.Patients in the S group were received 2μg/kg of sufentanil for postoperative analgesia,patients in the SK1 group were received 1 mg/kg of esketamine and 2μg/kg of sufentanil for postoperative analgesia,and patients in the SK2 group were received 2 mg/kg of esketamine and 2μg/kg of sufentanil for postoperative analgesia.At 1,4,24,and 48 hours after surgery,the analgesic effect of patients was evaluated using the numeric rating scale(NRS),and the sedation effect of patients was evaluated using the Ramsay sedation score.Depression of patients before and 48 hours after surgery was assessed by self-rating depression scale(SDS).The adverse reactions such as nausea and vomiting,dizziness and headache,respiratory depression,and mental symptoms within 48 hours after surgery of patients were recorded.Results The NRS scores 1,4,and 24 hours after surgery of patients in the SK1 group and the SK2 group were lower than those in the S group(P<0.05);there was no statistically significant difference in the NRS scores 48 hours after surgery of patients among the three groups(P>0.05);there was no statistically significant difference in the NRS scores at different postoperative points of patients between the SK1 and SK2 groups(P>0.05).The SDS scores 48 hours after surgery of patients in each group were lower than those before surgery(P<0.05).There was no statistically significant difference in the Ramsay scores at different postoperative points of patients among the three groups(P>0.05).The incidence of adverse reactions 48 hours after surgery in the SK2 group was higher than those in the S group and the SK1 group(P<0.05).Conclusion Using 1 mg/kg of esketamine combined with 2μg/kg of sufentanil after hip arthroplasty has a good analgesic effect without obvious increase of adverse reactions or significant effect on improving depression of patients.