不同剂量艾司氯胺酮预防瑞芬太尼诱发术后痛觉过敏的作用

Effect of different doses of esketamine in preventing remifentanil-induced postoperative hyperalgesia

目的探讨不同剂量艾司氯胺酮预防瑞芬太尼诱发术后痛觉过敏的作用。方法选择妇科择期全身麻醉下行腹腔镜手术病人120例,随机分为对照组(C组)、艾司氯胺酮低剂量组(L组)和艾司氯胺酮高剂量组(H组),每组40例。麻醉诱导前5 min,L组静脉注射艾司氯胺酮0.25 mg/kg,H组静脉注射艾司氯胺酮0.50 mg/kg,C组静脉注射等容量生理盐水。对3组机械痛阈、视觉模拟评分法(VAS)评分等指标进行比较。结果与C组和L组比较,H组睁眼时间、拔管时间延长(F=64.697、68.195,P<0.05)。与C组比较,L组和H组术后2、18 h时非优势手前臂和手术切口周围机械痛阈显著升高(F=80.458~387.248,P<0.05)。与术前1 d时比较,C组术后2、18 h时非优势手前臂和手术切口周围机械痛阈显著降低(F=2615.864,P<0.05)。与C组比较,L组和H组术后2、18 h时VAS评分显著降低(H=53.736、42.971,P<0.05)。3组术中瑞芬太尼用量、手术时间、术后补救镇痛率和不良反应发生率比较差异无统计学意义(P>0.05)。结论麻醉诱导前静脉注射艾司氯胺酮可减轻瑞芬太尼诱发的术后痛觉过敏,应用艾司氯胺酮0.25 mg/kg较应用0.50 mg/kg病人睁眼时间、拔管时间更短。

Objective To investigate the effect of different doses of esketamine in preventing postoperative hyperalgesia induced by remifentanil.Methods A total of 120 patients who underwent elective laparoscopic surgery under general anesthesia in Department of Gynecology were enrolled and randomly divided into control group(group C),low-dose esketamine group(group L),and high-dose esketamine group(group H),with 40 patients in each group.At 5 minutes before anesthesia induction,the patients in group L were given intravenous injection of esketamine 0.25 mg/kg,those in group H were given intravenous injection of esketamine 0.50 mg/kg,and those in group C were given intravenous injection of an equal volume of normal saline.The three groups were compared in terms of the indicators such as mechanical pain threshold and Visual Analogue Scale(VAS)score.Results Compared with group C and group L,group H had significantly longer eye-opening time and extubation time(F=64.697,68.195,P<0.05).Compared with group C,group L and group H had a significant increase in mechanical pain threshold around the non-dominant forearm and surgical incision at 2 and 18 hours after surgery(F=80.458-387.248,P<0.05).Group C had a significant reduction in mechanical pain threshold around the non-dominant forearm and surgical incision from day 1 before surgery to 2 and 18 hours after surgery(F=2615.864,P<0.05).Compared with group C,group L and group H had a significant reduction in VAS score at 2 and 18 hours after surgery(H=53.736,42.971,P<0.05).There were no significant differences between the three groups in the amount of remifentanil used during surgery,time of operation,postoperative salvage analgesia rate,and the incidence rate of adverse reactions(P>0.05).Conclusion Intravenous injection of esketamine before anesthesia induction can alleviate postoperative hyperalgesia induced by remifentanil,and compared with the patients receiving 0.50 mg/kg esketamine,the patients receiving 0.25 mg/kg esketamine tend to have shorter eye-opening time and extubation time.