艾司氯胺酮用于腹腔镜结肠癌根治术患者术后镇痛的有效性和安全性观察

Effectiveness and safety of esketamine for postoperative analgesia in patients undergoing laparoscopic radical colon cancer surgery

目的探讨艾司氯胺酮用于腹腔镜结肠癌根治术全麻患者术后镇痛的有效性和安全性。方法选择2022年2月至2022年7月于郑州大学附属肿瘤医院行全麻下腹腔镜结肠癌根治术的患者89例,按随机数字表法分为3组:对照组(C组,30例)、低剂量艾司氯胺酮组(K1组,29例)、高剂量艾司氯胺酮组(K2组,30例)。所有患者麻醉诱导和维持方案由其麻醉医师决定,镇痛药物限于舒芬太尼和瑞芬太尼。根据分组情况配置术后自控静脉镇痛泵:C组,舒芬太尼1.5μg/kg+托烷司琼5 mg;K1组,舒芬太尼1μg/kg+艾司氯胺酮1 mg/kg+托烷司琼5 mg;K2组,舒芬太尼1μg/kg+艾司氯胺酮2 mg/kg+托烷司琼5 mg。记录患者术后48 h的视觉模拟评分法(VAS)疼痛评分、Ramsay镇静评分、简易精神状态检查(MMSE)评分、抑郁症自测量表(SDS)评分和术后48 h内镇痛泵按压次数、不良反应(恶心、呕吐、瘙痒、尿潴留)发生情况。结果与C组比较:K1组术后48 h VAS疼痛评分较高(P<0.05),术后48 h内镇痛泵按压次数较多(P<0.05);K1组、K2组术后48 h SDS评分较低(均P<0.05)。与K1组比较,K2组术后48 h VAS疼痛评分较低(P<0.05),术后48 h内镇痛泵按压次数较少(P<0.05)。3组患者术后48 h Ramsay镇静评分和MMSE评分差异无统计学意义(均P>0.05)。与C组比较,K1组、K2组术后48 h内恶心发生率较低(均P<0.05);其余不良反应发生率差异无统计学意义(均P>0.05)。结论艾司氯胺酮2 mg/kg复合舒芬太尼1μg/kg可以安全、有效地应用于腹腔镜结肠癌根治术患者的术后镇痛。

Objective To evaluate the effectiveness and safety of esketamine for postoperative analgesia in patients undergoing laparoscopic radical colon cancer surgery under general anesthesia.Methods A total of 89 patients who underwent laparoscopic radical colon cancer surgery under general anesthesia in Affiliated Cancer Hospital of Zhengzhou University from February 2022 to July 2022 were selected.According to the random number table method,the patients were divided into three groups:a control group(group C,n=30),a low‑dose esketamine group(group K1,n=29),and a high‑dose esketamine group(group K2,n=30).Their anesthesia induction and maintenance regimens were determined by corresponding anesthesiologists,and the used analgesics were limited to sufentanil and remifentanil.According to the grouping,postoperative patient‑controlled intravenous analgesia pumps were used:sufentanil 1.5μg/kg+tropisetron 5 mg in group C;sufentanil 1μg/kg+esketamine 1 mg/kg+tropisetron 5 mg in group K1;and sufentanil 1μg/kg+esketamine 2 mg/kg+tropisetron 5 mg in group K2.Their Visual Analogue Scale(VAS)score,Ramsay score,the Mini‑Mental State Examination(MMSE)score,the Self‑Rating Depression Scale(SDS)score,the number of analgesic pump compressions within 48 h after surgery,and the incidences of adverse reactions(nausea,vomiting,itching,and urinary retention)were recorded.Results Compared with group C,group K1 showed increases in VAS score at postoperative 48 h(P<0.05),and the number of analgesic pump compressions within 48 h after surgery(P<0.05),while SDS scores at postoperative 48 h decreased in groups K1 and K2(all P<0.05).Compared with group K1,group K2 presented reduced VAS scores at postoperative 48 h(P<0.05),with a decreased number of analgesic pump compressions within 48 h after surgery(P<0.05).There was no statistical difference in Ramsay score and MMSE score at postoperative 48 h among the three groups(all P>0.05).The incidence of nausea within 48 h after surgery in groups K1 and K2 was lower than that in group C(all P<0.05).There was no statistical difference in the incidence of other adverse reactions(all P>0.05).Conclusion It is safe and effective to use esketamine tropisetron 2 mg/kg+sufentanil 1μg/kg for postoperative analgesia in patients undergoing laparoscopic radical colon cancer surgery.